Healthcare Provider Details

I. General information

NPI: 1790056166
Provider Name (Legal Business Name): RHYS SMITH DAVID RN, CPNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/18/2012
Last Update Date: 02/14/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3020 CHILDRENS WAY
SAN DIEGO CA
92123-4223
US

IV. Provider business mailing address

8110 BIRMINGHAM WAY
SAN DIEGO CA
92123-2758
US

V. Phone/Fax

Practice location:
  • Phone: 858-966-4075
  • Fax:
Mailing address:
  • Phone: 858-966-4003
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberNP 21537
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: