MEDICARE: DR. BRENDA CAROL SMITH MD

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	174400000X	Specialist	G047927	CA

General Provider Information

NPI Number	:	1427228329
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRENDA CAROL SMITH MD

Provider Business Mailing Address
First Line	:	1800 FAIR OAKS AVE # C
Second Line	:
City	:	SOUTH PASADENA
State	:	CA
Zip	:	91030-4776
Country	:	US
Telephone Number	:	626-799-4437
Fax Number	:

Provider Business Practice Location Address
First Line	:	1800 FAIR OAKS AVE # C
Second Line	:
City	:	SOUTH PASADENA
State	:	CA
Zip	:	91030-4776
Country	:	US
Telephone Number	:	626-799-4437
Fax Number	:

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

Provider Enumeration Date	:	03/06/2008
Last Update Date	:	06/13/2008

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