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General NPI Number Information
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NPI Number | 1437644689
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Entity Type | Individual
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Provider Name | WAYNE RANDOLPH SMITH HT
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Gender | Male
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Dates
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Enumeration Date | 06/28/2018
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Last Update Date | 06/28/2018
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Provider Practice Location Address
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Address Line | 1615 HILL RD STE C
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City | NOVATO
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State | CA
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Zip | 94947-4338
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Country | US
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Telephone | 415-209-6076
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Fax |
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Provider Business Mailing Address
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Address Line | 9 WEYBRIDGE CT
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City | OAKLAND
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State | CA
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Zip | 94611-2749
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Country | US
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Telephone |
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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 | 246RH0600X
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Taxonomy Name | Histology Technician
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License Number | 25226
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License Number State | IL
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