Healthcare Provider Details

I. General information

NPI: 1811930357
Provider Name (Legal Business Name): DAVID J SMITH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/13/2006
Last Update Date: 03/09/2021
Certification Date: 03/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3703 CAMINO DEL RIO S 210
SAN DIEGO CA
92108-4031
US

IV. Provider business mailing address

3703 CAMINO DEL RIO S 210
SAN DIEGO CA
92108-4031
US

V. Phone/Fax

Practice location:
  • Phone: 619-640-5555
  • Fax: 619-640-5550
Mailing address:
  • Phone: 619-640-5555
  • Fax: 619-640-5550

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License NumberGG599Z
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: