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NPI Code Detail

MEDICARE: SHAWNAE M SMITH

MEDICARE: SHAWNAE M 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
1171M00000XCase Manager/Care Coordinator

General Provider Information

NPI Number : 1497884258
Entity Type Code : Individual
Provider Name (Legal Business Name) : SHAWNAE M SMITH
Provider Business Mailing Address
First Line : 2617 BUCKINGHAM RD
Second Line :
City : LOS ANGELES
State : CA
Zip : 90016-3068
Country : US
Telephone Number : 323-732-4853
Fax Number :
Provider Business Practice Location Address
First Line : 7120 FRANKLIN AVE
Second Line :
City : LOS ANGELES
State : CA
Zip : 90046-3002
Country : US
Telephone Number : 323-876-0550
Fax Number : 323-436-7044
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/05/2007
Last Update Date : 07/08/2007

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