Healthcare Provider Details

I. General information

NPI: 1013085380
Provider Name (Legal Business Name): MARIANNE SMITH CMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/02/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

870 MARKET ST 721
SAN FRANCISCO CA
94102-3002
US

IV. Provider business mailing address

795 GEARY ST 608
SAN FRANCISCO CA
94109-7364
US

V. Phone/Fax

Practice location:
  • Phone: 415-412-7366
  • Fax:
Mailing address:
  • Phone: 415-412-7366
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code302R00000X
TaxonomyHealth Maintenance Organization
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: