Healthcare Provider Details

I. General information

NPI: 1144860651
Provider Name (Legal Business Name): DAVID COOPER SMITH FNP-BC, PHN, CNL
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/13/2020
Last Update Date: 10/09/2026
Certification Date: 10/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55497 VAN BUREN ST
THERMAL CA
92274-9412
US

IV. Provider business mailing address

82879 KINGSBORO LN
INDIO CA
92201-9667
US

V. Phone/Fax

Practice location:
  • Phone: 760-399-4526
  • Fax: 760-416-1651
Mailing address:
  • Phone: 415-341-7742
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberNP95032693
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: