Healthcare Provider Details

I. General information

NPI: 1437966777
Provider Name (Legal Business Name): MONICA J SMITH CSFA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/11/2024
Last Update Date: 12/11/2024
Certification Date: 12/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2400 UNSER BLVD SE
RIO RANCHO NM
87124-3392
US

IV. Provider business mailing address

5300 ANTEQUERA RD NW APT 1902
ALBUQUERQUE NM
87120-4588
US

V. Phone/Fax

Practice location:
  • Phone: 505-253-6100
  • Fax:
Mailing address:
  • Phone: 505-681-2221
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZC0007X
TaxonomySurgical Assistant
License Number
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: