Healthcare Provider Details

I. General information

NPI: 1619792306
Provider Name (Legal Business Name): CAMILA BAEZ-SMITH NP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/19/2024
Last Update Date: 11/19/2024
Certification Date: 11/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4440 BROCKTON AVE STE 420
RIVERSIDE CA
92501-4026
US

IV. Provider business mailing address

PO BOX 100
WILMINGTON CA
90748-0100
US

V. Phone/Fax

Practice location:
  • Phone: 951-684-8020
  • Fax:
Mailing address:
  • Phone: 310-944-2426
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number95032238
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: