Healthcare Provider Details

I. General information

NPI: 1245373109
Provider Name (Legal Business Name): LATISHA ANN STEWART SMITH NURSE PRACTTIONER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/14/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14445 OLIVE VIEW DR
SYLMAR CA
91342-1437
US

IV. Provider business mailing address

1950 MENTONE AVE
PASADENA CA
91103-1429
US

V. Phone/Fax

Practice location:
  • Phone: 818-364-3163
  • Fax: 818-364-3383
Mailing address:
  • Phone: 626-797-9574
  • Fax: 626-797-9558

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number370062
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License Number370062
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: