Healthcare Provider Details

I. General information

NPI: 1336586999
Provider Name (Legal Business Name): JOANN SMITH SMITH CNM, ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/22/2013
Last Update Date: 07/02/2020
Certification Date: 07/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

91275 66TH AVE SUITE 500
MECCA CA
92254-6515
US

IV. Provider business mailing address

PO BOX 1378
MECCA CA
92254-1378
US

V. Phone/Fax

Practice location:
  • Phone: 760-396-1249
  • Fax: 760-396-1253
Mailing address:
  • Phone: 760-396-1249
  • Fax: 760-396-1253

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number1435
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License NumberRN122050
License Number StateGA
# 3
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number235806
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: