MEDICARE: KEIANA SHARICE SMITH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	374700000X	Technician

General Provider Information

NPI Number	:	1073104097
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KEIANA SHARICE SMITH

Provider Business Mailing Address
First Line	:	1055 E. COLORADO BLVD. SUITE 560 PASADENA, CA
Second Line	:
City	:	PASADENA
State	:	CA
Zip	:	91106
Country	:	US
Telephone Number	:	818-241-6780
Fax Number	:	818-241-6853

Provider Business Practice Location Address
First Line	:	1055 E. COLORADO BLVD. SUITE 560 PASADENA, CA
Second Line	:
City	:	PASADENA
State	:	CA
Zip	:	91106-9110
Country	:	US
Telephone Number	:	818-241-6780
Fax Number	:	818-241-6853

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/02/2021
Last Update Date	:	02/02/2021

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Directions to “ KEIANA SHARICE SMITH ” Practice Location

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