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NPI Code Detail

MEDICARE: MR. RYAN MICHAEL SMITH C.A.T.C

MEDICARE: MR. RYAN MICHAEL SMITH C.A.T.C
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
1101YA0400XAddiction (Substance Use Disorder) Counselor178536CA

General Provider Information

NPI Number : 1265955942
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. RYAN MICHAEL SMITH C.A.T.C
Provider Business Mailing Address
First Line : 1003 S BEACON ST
Second Line :
City : SAN PEDRO
State : CA
Zip : 90731
Country : US
Telephone Number : 310-514-4940
Fax Number :
Provider Business Practice Location Address
First Line : 1003 S BEACON ST
Second Line :
City : SAN PEDRO
State : CA
Zip : 90731-4324
Country : US
Telephone Number : 310-514-4940
Fax Number : 310-514-4940
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/25/2017
Last Update Date : 07/25/2017

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