Healthcare Provider Details

I. General information

NPI: 1407366313
Provider Name (Legal Business Name): YONUI K SMITH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/05/2017
Last Update Date: 10/05/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

655 S CENTRAL VALLEY HWY
SHAFTER CA
93263-2790
US

IV. Provider business mailing address

3517 SELIGMAN DR.
BAKERSFIELD CA
93309
US

V. Phone/Fax

Practice location:
  • Phone: 661-746-9194
  • Fax:
Mailing address:
  • Phone: 661-496-8940
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License Number233665
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: