Healthcare Provider Details

I. General information

NPI: 1245359397
Provider Name (Legal Business Name): ALAN SMITH PHD, MPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6255 MISSION GORGE RD
SAN DIEGO CA
92120-3505
US

IV. Provider business mailing address

4702 ORCUTT AVE
SAN DIEGO CA
92120-2624
US

V. Phone/Fax

Practice location:
  • Phone: 619-285-6528
  • Fax:
Mailing address:
  • Phone: 619-269-7392
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1744R1102X
TaxonomyResearch Study Specialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: