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General NPI Number Information
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NPI Number | 1518508092
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Entity Type | Individual
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Provider Name | VIDA K SMITH
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Gender | Female
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Dates
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Enumeration Date | 10/04/2019
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Last Update Date | 10/04/2019
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Provider Practice Location Address
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Address Line | 35793 SUSAN DR
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City | WILDOMAR
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State | CA
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Zip | 92595-7106
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Country | US
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Telephone | 951-970-9785
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Fax |
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Provider Business Mailing Address
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Address Line | 35793 SUSAN DR
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City | WILDOMAR
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State | CA
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Zip | 92595-7106
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Country | US
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Telephone | 951-970-9785
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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 | 164X00000X
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Taxonomy Name | Licensed Vocational Nurse
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License Number | 230210
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License Number State | CA
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