=====================================================
General NPI Number Information
=====================================================
NPI Number | 1720542723
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | COMPUTERSMITHS LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/24/2019
-----------------------------------------------------
Last Update Date | 01/24/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 24560 SILVER CLOUD CT STE 103
-----------------------------------------------------
City | MONTEREY
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93940-6560
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 831-324-0772
-----------------------------------------------------
Fax | 831-324-0292
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 24560 SILVER CLOUD CT STE 103
-----------------------------------------------------
City | MONTEREY
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93940-6560
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 831-324-0772
-----------------------------------------------------
Fax | 831-324-0292
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | LAB DIRECTOR
-----------------------------------------------------
Name | SPENSER KUO SMITH
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 831-324-0772
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 246RP1900X
-----------------------------------------------------
Taxonomy Name | Phlebotomy Technician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------