Healthcare Provider Details

I. General information

NPI: 1770677536
Provider Name (Legal Business Name): BARBARA SMITH N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 02/05/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6155 CORNERSTONE CT E STE 220
SAN DIEGO CA
92121-4736
US

IV. Provider business mailing address

6155 CORNERSTONE CT E STE 220
SAN DIEGO CA
92121-4736
US

V. Phone/Fax

Practice location:
  • Phone: 858-458-2992
  • Fax: 858-362-4027
Mailing address:
  • Phone: 858-458-2992
  • Fax: 858-362-4027

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4609
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: