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General NPI Number Information
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NPI Number | 1649464397
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Entity Type | Individual
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Provider Name | ROSELYN RODRIGUEZ SMITH PA-C
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Gender | Female
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Dates
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Enumeration Date | 09/05/2007
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Last Update Date | 07/05/2024
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Provider Practice Location Address
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Address Line | 1520 NUTMEG PL STE 101
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City | COSTA MESA
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State | CA
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Zip | 92626-2557
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Country | US
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Telephone | 714-922-4194
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 513980
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City | LOS ANGELES
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State | CA
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Zip | 90051-3980
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Country | US
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Telephone | 714-456-2911
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Fax | 714-456-8383
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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 | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | PA12383
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | PA12383
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA12383
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License Number State | CA
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