Healthcare Provider Details

I. General information

NPI: 1033028014
Provider Name (Legal Business Name): AMBER SMITH AGPCNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/04/2026
Last Update Date: 09/04/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5228 HERSHOLT AVE
LAKEWOOD CA
90712-2733
US

IV. Provider business mailing address

5228 HERSHOLT AVE
LAKEWOOD CA
90712-2733
US

V. Phone/Fax

Practice location:
  • Phone: 562-965-7656
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number95032471
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: