Healthcare Provider Details

I. General information

NPI: 1417938911
Provider Name (Legal Business Name): AMBER AMALIA SMITH M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 11/10/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2315 STOCKTON BLVD
SACRAMENTO CA
95817-2201
US

IV. Provider business mailing address

4860 Y ST SUITE 3700
SACRAMENTO CA
95817-2307
US

V. Phone/Fax

Practice location:
  • Phone: 916-734-3514
  • Fax: 916-734-6525
Mailing address:
  • Phone: 916-734-3514
  • Fax: 916-734-6525

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberA90349
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: