Healthcare Provider Details

I. General information

NPI: 1962601500
Provider Name (Legal Business Name): LATOYA ANDRECIA GREEN-SMITH M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2007
Last Update Date: 03/24/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

540 E ARTESIA BLVD
LONG BEACH CA
90805-1476
US

IV. Provider business mailing address

6501 GARFIELD AVE SUITE 100
BELL GARDENS CA
90201-1805
US

V. Phone/Fax

Practice location:
  • Phone: 661-723-7416
  • Fax: 661-723-9975
Mailing address:
  • Phone: 562-499-6191
  • Fax: 562-499-6171

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA111079
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: