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General NPI Number Information
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NPI Number | 1609211291
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Entity Type | Organization
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Legal Business Name | CLARISA I. SMITH, MD PLLC
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Dates
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Enumeration Date | 05/08/2013
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Last Update Date | 09/10/2013
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Provider Practice Location Address
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Address Line | 3001 N MAIN ST SUITE 1C
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City | PRESCOTT VALLEY
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State | AZ
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Zip | 86314-1216
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Country | US
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Telephone | 928-458-5470
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Fax | 928-458-5979
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Provider Business Mailing Address
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Address Line | 111 CHESTER AVE
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City | ANNAPOLIS
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State | MD
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Zip | 21403-3311
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Country | US
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Telephone | 602-431-1152
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Fax | 602-431-2149
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | KIRSTEN A SORENSEN
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Credential |
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Telephone | 602-431-1152
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 35537
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License Number State | AZ
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