Healthcare Provider Details

I. General information

NPI: 1023049483
Provider Name (Legal Business Name): CRAIG V SMITH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/05/2006
Last Update Date: 10/11/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23661 PACIFIC COAST HWY
MALIBU CA
90265-4825
US

IV. Provider business mailing address

2042 S OXFORD AVE
LOS ANGELES CA
90018-1529
US

V. Phone/Fax

Practice location:
  • Phone: 310-341-0188
  • Fax:
Mailing address:
  • Phone: 323-737-8727
  • Fax: 323-737-8727

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License NumberG61164
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberG61164
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberG61164
License Number StateCA
# 4
Primary TaxonomyY
Taxonomy Code207RA0401X
TaxonomyAddiction Medicine (Internal Medicine) Physician
License NumberG61164
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: