Healthcare Provider Details

I. General information

NPI: 1326510090
Provider Name (Legal Business Name): TRICINA L SMITH RN, PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/19/2018
Last Update Date: 03/10/2026
Certification Date: 03/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

820 E GILBERT ST
SAN BERNARDINO CA
92415-0928
US

IV. Provider business mailing address

5650 OLIVE AVE
RIALTO CA
92377-3958
US

V. Phone/Fax

Practice location:
  • Phone: 909-965-9711
  • Fax:
Mailing address:
  • Phone: 909-965-9711
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number95033916
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number807028
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: