Healthcare Provider Details

I. General information

NPI: 1437977691
Provider Name (Legal Business Name): ALICIA SMITH FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/27/2024
Last Update Date: 09/27/2024
Certification Date: 09/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4683 CHABOT DR STE 203
PLEASANTON CA
94588-3830
US

IV. Provider business mailing address

4683 CHABOT DR STE 293
PLEASANTON CA
94588-3830
US

V. Phone/Fax

Practice location:
  • Phone: 949-288-1292
  • Fax:
Mailing address:
  • Phone: 949-288-1292
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95032070
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: