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General NPI Number Information
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NPI Number | 1992101083
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Entity Type | Organization
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Legal Business Name | DENISE A.B. SMITH M.D., PH.D., PC
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Dates
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Enumeration Date | 11/17/2014
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Last Update Date | 11/17/2014
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Provider Practice Location Address
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Address Line | 833 AUTO CENTER DR STE DANDE
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City | PALMDALE
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State | CA
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Zip | 93551-4488
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Country | US
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Telephone | 513-479-5186
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Fax |
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Provider Business Mailing Address
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Address Line | 833 AUTO CENTER DR STE DANDE
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City | PALMDALE
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State | CA
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Zip | 93551-4488
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CEO/VASCULAR SURGEON
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Name | DR. DENISE A.B. SMITH
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Credential | M.D., PH.D.
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Telephone | 513-479-5186
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2086S0129X
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Taxonomy Name | Vascular Surgery Physician
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License Number | A131396
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License Number State | CA
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