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General NPI Number Information
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NPI Number | 1609064658
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Entity Type | Organization
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Legal Business Name | BRENDA C. SMITH M.D., INC.
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Dates
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Enumeration Date | 10/03/2007
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Last Update Date | 06/13/2008
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Provider Practice Location Address
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Address Line | 1800 FAIR OAKS AVE SUITE C
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City | SOUTH PASADENA
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State | CA
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Zip | 91030-4776
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Country | US
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Telephone | 626-799-4437
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Fax | 626-441-6300
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Provider Business Mailing Address
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Address Line | PO BOX 93457
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City | PASADENA
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State | CA
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Zip | 91109-3457
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Country | US
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Telephone | 626-799-4437
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Fax | 626-441-6300
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Authorized Official
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Title or Position | CEO
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Name | DR. BRENDA CAROL SMITH
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Credential | M.D.
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Telephone | 626-799-4437
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | G47927
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License Number State | CA
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