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General NPI Number Information
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NPI Number | 1972645562
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Entity Type | Individual
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Provider Name | JEFFREY STUART SMITH L.AC.
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Gender | Male
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Dates
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Enumeration Date | 02/12/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 56969 YUCCA TRL STE A
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City | YUCCA VALLEY
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State | CA
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Zip | 92284-3797
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Country | US
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Telephone | 769-365-5677
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Fax |
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Provider Business Mailing Address
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Address Line | 7340 CONDALIA AVE APT 2
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City | YUCCA VALLEY
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State | CA
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Zip | 92284-7905
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Country | US
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Telephone | 760-369-3156
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Fax |
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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 | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | AC6187
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License Number State | CA
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