Healthcare Provider Details

I. General information

NPI: 1760442339
Provider Name (Legal Business Name): NANCY A SMITH MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2006
Last Update Date: 11/29/2025
Certification Date: 11/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1661 GOLDEN RAIN RD
SEAL BEACH CA
90740-4907
US

IV. Provider business mailing address

PO BOX 35380
LAS VEGAS NV
89133-5380
US

V. Phone/Fax

Practice location:
  • Phone: 562-493-9581
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA60394
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: