Healthcare Provider Details

I. General information

NPI: 1477868206
Provider Name (Legal Business Name): LISA SMALLING NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/17/2010
Last Update Date: 08/17/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2653 ELM AVE STE 100
LONG BEACH CA
90806-1654
US

IV. Provider business mailing address

2653 ELM AVE STE 100
LONG BEACH CA
90806-1654
US

V. Phone/Fax

Practice location:
  • Phone: 562-728-5027
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number19290
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number605253
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: