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NPI Code Detail

MEDICARE: MICHELLE SMITH

MEDICARE: MICHELLE 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
1103TS0200XSchool PsychologistCA

General Provider Information

NPI Number : 1689521197
Entity Type Code : Individual
Provider Name (Legal Business Name) : MICHELLE SMITH
Provider Business Mailing Address
First Line : 300 E SURFSIDE DR
Second Line :
City : PORT HUENEME
State : CA
Zip : 93041-3355
Country : US
Telephone Number : 805-760-1190
Fax Number :
Provider Business Practice Location Address
First Line : 300 E SURFSIDE DR
Second Line :
City : PORT HUENEME
State : CA
Zip : 93041-3355
Country : US
Telephone Number : 805-760-1190
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/13/2026
Last Update Date : 03/13/2026

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Directions to “ MICHELLE SMITH ” Practice Location

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