Healthcare Provider Details

I. General information

NPI: 1538893565
Provider Name (Legal Business Name): ANNA MARIE SMITH LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/14/2022
Last Update Date: 07/14/2022
Certification Date: 07/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1643 GAVIOTA AVE
LONG BEACH CA
90813-2457
US

IV. Provider business mailing address

1643 GAVIOTA AVE
LONG BEACH CA
90813-2457
US

V. Phone/Fax

Practice location:
  • Phone: 850-628-0642
  • Fax:
Mailing address:
  • Phone: 850-628-0642
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number89441
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: