Healthcare Provider Details

I. General information

NPI: 1396083929
Provider Name (Legal Business Name): CHRISTINA MARIA VALLE-SMITH CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/16/2013
Last Update Date: 01/16/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1411 E 31ST ST
OAKLAND CA
94602-1018
US

IV. Provider business mailing address

1718 CAMPANULA DR
SAN RAMON CA
94582-5154
US

V. Phone/Fax

Practice location:
  • Phone: 415-310-1104
  • Fax:
Mailing address:
  • Phone: 415-310-1104
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number91573
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: