Healthcare Provider Details

I. General information

NPI: 1942426903
Provider Name (Legal Business Name): LETITIA RENE SMITH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/18/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3717 S LA BREA AVE SUITE # 324
LOS ANGELES CA
90016-5354
US

IV. Provider business mailing address

3717 S LA BREA AVE SUITE# 324
LOS ANGELES CA
90016-5354
US

V. Phone/Fax

Practice location:
  • Phone: 310-251-8947
  • Fax:
Mailing address:
  • Phone: 310-251-8947
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number477591
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number477591
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: