Healthcare Provider Details

I. General information

NPI: 1992724538
Provider Name (Legal Business Name): CARLOS ALBERTO SMITH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2006
Last Update Date: 06/13/2025
Certification Date: 06/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1907 BORDER AVE
TORRANCE CA
90501-3606
US

IV. Provider business mailing address

PO BOX 10030
DAYTONA BEACH FL
32120-0030
US

V. Phone/Fax

Practice location:
  • Phone: 844-443-6246
  • Fax: 833-907-2235
Mailing address:
  • Phone: 386-274-7800
  • Fax: 386-274-7801

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number173466
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberME93609
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: