Healthcare Provider Details

I. General information

NPI: 1609772409
Provider Name (Legal Business Name): MARIA SMITH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/19/2026
Last Update Date: 10/19/2026
Certification Date: 10/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3081 N MAIN ST APT 29
WALNUT CREEK CA
94597-1981
US

IV. Provider business mailing address

3081 N MAIN ST APT 29
WALNUT CREEK CA
94597-1981
US

V. Phone/Fax

Practice location:
  • Phone: 925-266-2733
  • Fax:
Mailing address:
  • Phone: 925-266-2733
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License NumberPSA3AW
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: