Healthcare Provider Details

I. General information

NPI: 1043045370
Provider Name (Legal Business Name): GARRETT RYAN SMITH CPT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/05/2024
Last Update Date: 09/05/2024
Certification Date: 09/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1428 VIA GALICIA
PLS VRDS EST CA
90274-2865
US

IV. Provider business mailing address

1428 VIA GALICIA
PLS VRDS EST CA
90274-2865
US

V. Phone/Fax

Practice location:
  • Phone: 310-719-5265
  • Fax:
Mailing address:
  • Phone: 310-719-5265
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: