Healthcare Provider Details

I. General information

NPI: 1609941632
Provider Name (Legal Business Name): RAYMOND N SMITH FNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/22/2006
Last Update Date: 04/27/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

160 E ARTESIA ST SUITE 220
POMONA CA
91767-2900
US

IV. Provider business mailing address

840 TOWNE CENTER DR
POMONA CA
91767-5900
US

V. Phone/Fax

Practice location:
  • Phone: 909-865-1020
  • Fax: 909-865-1202
Mailing address:
  • Phone: 909-398-1500
  • Fax: 909-398-1573

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number14029
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: