Healthcare Provider Details

I. General information

NPI: 1073916201
Provider Name (Legal Business Name): LYNDA SMITH MSPA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/02/2014
Last Update Date: 05/10/2024
Certification Date: 05/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6080 CENTER DR STE 600
LOS ANGELES CA
90045-1540
US

IV. Provider business mailing address

115 S ALAMEDA LN
SAN CLEMENTE CA
92672-5304
US

V. Phone/Fax

Practice location:
  • Phone: 424-512-2300
  • Fax:
Mailing address:
  • Phone: 714-318-4030
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number17657
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: