Healthcare Provider Details

I. General information

NPI: 1366523581
Provider Name (Legal Business Name): MARGARET SMYKLO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/17/2006
Last Update Date: 07/02/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13425 SOUSA LN
SARATOGA CA
95070-4637
US

IV. Provider business mailing address

PO BOX 5040
SAN JOSE CA
95150-5040
US

V. Phone/Fax

Practice location:
  • Phone: 650-465-3132
  • Fax:
Mailing address:
  • Phone: 408-448-9210
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA035760
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2080P0203X
TaxonomyPediatric Critical Care Medicine Physician
License NumberA035760
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: