MEDICARE: BRENDA C. SMITH M.D., INC.

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	G47927	CA

General Provider Information

NPI Number	:	1609064658
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BRENDA C. SMITH M.D., INC.

Provider Business Mailing Address
First Line	:	PO BOX 93457
Second Line	:
City	:	PASADENA
State	:	CA
Zip	:	91109-3457
Country	:	US
Telephone Number	:	626-799-4437
Fax Number	:	626-441-6300

Provider Business Practice Location Address
First Line	:	1800 FAIR OAKS AVE
Second Line	:	SUITE C
City	:	SOUTH PASADENA
State	:	CA
Zip	:	91030-4776
Country	:	US
Telephone Number	:	626-799-4437
Fax Number	:	626-441-6300

Authorized Official
Title or Position	:	CEO
Name	:	DR. BRENDA CAROL SMITH
Credential	:	M.D.
Telephone Number	:	626-799-4437

Provider Enumeration Date	:	10/03/2007
Last Update Date	:	06/13/2008

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