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General NPI Number Information
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NPI Number | 1720126089
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Entity Type | Organization
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Legal Business Name | RICHARD C. SMITH, M.D. A PROFESSIONAL CORPORATION
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Dates
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Enumeration Date | 02/01/2007
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Last Update Date | 12/11/2007
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Provider Practice Location Address
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Address Line | 1350 W 6TH ST SUITE 2
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City | SAN PEDRO
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State | CA
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Zip | 90732-3544
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Country | US
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Telephone | 310-833-2428
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Fax | 310-833-7850
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Provider Business Mailing Address
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Address Line | 1350 W 6TH ST SUITE 2
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City | SAN PEDRO
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State | CA
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Zip | 90732-3544
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Country | US
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Telephone | 310-833-2428
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Fax | 310-833-7850
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Authorized Official
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Title or Position | PRES.
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Name | DR. RICHARD CHARLES SMITH
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Credential | M.D.
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Telephone | 310-833-2428
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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 | C31822
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License Number State | CA
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