Healthcare Provider Details

I. General information

NPI: 1275448474
Provider Name (Legal Business Name): SAMMANTHA A SMITH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/14/2026
Last Update Date: 08/14/2026
Certification Date: 08/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3689 RIDGE LINE DR
SAN BERNARDINO CA
92407-4176
US

IV. Provider business mailing address

3689 RIDGE LINE DR
SAN BERNARDINO CA
92407-4176
US

V. Phone/Fax

Practice location:
  • Phone: 626-383-9444
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2278E0002X
TaxonomyEmergency Care Certified Respiratory Therapist
License Number48430
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2278H0200X
TaxonomyHome Health Certified Respiratory Therapist
License Number48430
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code2278S1500X
TaxonomySNF/Subacute Care Certified Respiratory Therapist
License Number48430
License Number StateCA
# 4
Primary TaxonomyY
Taxonomy Code2279G1100X
TaxonomyGeneral Care Registered Respiratory Therapist
License Number48430
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: