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General NPI Number Information
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NPI Number | 1528453537
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Entity Type | Individual
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Provider Name | NICOLE RENEE SMITH M.D.
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Gender | Female
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Dates
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Enumeration Date | 04/06/2015
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Last Update Date | 07/15/2025
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Provider Practice Location Address
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Address Line | 2150 HILLHURST AVE
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City | LOS ANGELES
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State | CA
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Zip | 90027-2012
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Country | US
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Telephone | 909-323-2461
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Fax | 803-590-6355
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Provider Business Mailing Address
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Address Line | 2150 HILLHURST AVE
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City | LOS ANGELES
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State | CA
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Zip | 90027-2012
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Country | US
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Telephone | 909-323-2461
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Fax | 803-590-6355
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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 | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | MD210001441
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License Number State | DC
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Taxonomy #2
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 306826
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License Number State | NY
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Taxonomy #3
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | D0085661
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License Number State | MD
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Taxonomy #4
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | A185171
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License Number State | CA
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