Healthcare Provider Details

I. General information

NPI: 1376488585
Provider Name (Legal Business Name): NICOLE SMITH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/22/2026
Last Update Date: 04/22/2026
Certification Date: 04/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 E CHESTNUT AVE
SANTA ANA CA
92701-6322
US

IV. Provider business mailing address

27921 SHEFFIELD
MISSION VIEJO CA
92692-2806
US

V. Phone/Fax

Practice location:
  • Phone: 714-558-5501
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number8215
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: