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General NPI Number Information
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NPI Number | 1104782564
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Entity Type | Individual
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Provider Name | ALYCIA RENEE SMITH RN
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Gender | Female
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Dates
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Enumeration Date | 12/30/2025
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Last Update Date | 12/30/2025
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Provider Practice Location Address
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Address Line | 630 CENTER ST UNIT B
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City | COSTA MESA
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State | CA
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Zip | 92627-2709
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Country | US
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Telephone | 707-541-8731
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Fax | 949-209-1995
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Provider Business Mailing Address
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Address Line | 630 CENTER ST UNIT B
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City | COSTA MESA
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State | CA
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Zip | 92627-2709
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Country | US
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Telephone |
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Fax | 949-209-1995
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163WA2000X
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Taxonomy Name | Administrator Registered Nurse
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License Number | RN95368561
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License Number State | CA
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