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General NPI Number Information
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NPI Number | 1376124651
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Entity Type | Individual
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Provider Name | BRIANNA JAZMINE SMITH PA-C
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Gender | Female
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Dates
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Enumeration Date | 04/18/2021
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Last Update Date | 12/09/2024
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Provider Practice Location Address
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Address Line | 1501 TROUSDALE DR
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City | BURLINGAME
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State | CA
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Zip | 94010-4506
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Country | US
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Telephone | 650-652-8787
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 276950
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City | SACRAMENTO
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State | CA
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Zip | 95827-6950
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Country | US
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Telephone | 650-652-8787
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Fax |
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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 | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | PA.0006885
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License Number State | CO
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Taxonomy #2
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | PA64140
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License Number State | CA
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