MEDICARE: LETITIA RENE 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
1	163W00000X	Registered Nurse	477591	CA
2	163WC0400X	Case Management Registered Nurse	477591	CA

General Provider Information

NPI Number	:	1942426903
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LETITIA RENE SMITH

Provider Business Mailing Address
First Line	:	3717 S LA BREA AVE
Second Line	:	SUITE# 324
City	:	LOS ANGELES
State	:	CA
Zip	:	90016-5354
Country	:	US
Telephone Number	:	310-251-8947
Fax Number	:

Provider Business Practice Location Address
First Line	:	3717 S LA BREA AVE
Second Line	:	SUITE # 324
City	:	LOS ANGELES
State	:	CA
Zip	:	90016-5354
Country	:	US
Telephone Number	:	310-251-8947
Fax Number	:

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

Provider Enumeration Date	:	04/18/2007
Last Update Date	:	09/11/2025

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