Healthcare Provider Details

I. General information

NPI: 1891721643
Provider Name (Legal Business Name): EVELYN MARIE SMITH AU.D., FAAA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2006
Last Update Date: 08/26/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4282 GENESEE AVE STE 301
SAN DIEGO CA
92117-4998
US

IV. Provider business mailing address

4282 GENESEE AVE STE 301
SAN DIEGO CA
92117-4998
US

V. Phone/Fax

Practice location:
  • Phone: 858-279-3277
  • Fax: 858-279-3281
Mailing address:
  • Phone: 858-279-3277
  • Fax: 858-279-3281

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License NumberAU1781
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: