Healthcare Provider Details

I. General information

NPI: 1669581518
Provider Name (Legal Business Name): ROBERT LAWRENCE SMITH RN CCP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 09/16/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1637 WRIGHT AVENUE
SUNNYVALE CA
94087-5251
US

IV. Provider business mailing address

1637 WRIGHT AVENUE
SUNNYVALE CA
94087-5251
US

V. Phone/Fax

Practice location:
  • Phone: 408-737-8894
  • Fax: 408-737-8894
Mailing address:
  • Phone: 408-737-8894
  • Fax: 408-737-8894

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number283697
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code242T00000X
TaxonomyPerfusionist
License Number799111
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: