MEDICARE: LATOYA ANDRECIA GREEN-SMITH M.D.

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	208000000X	Pediatrics Physician	A111079	CA

General Provider Information

NPI Number	:	1962601500
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LATOYA ANDRECIA GREEN-SMITH M.D.

Provider Business Mailing Address
First Line	:	6501 GARFIELD AVE
Second Line	:	SUITE 100
City	:	BELL GARDENS
State	:	CA
Zip	:	90201-1805
Country	:	US
Telephone Number	:	562-499-6191
Fax Number	:	562-499-6171

Provider Business Practice Location Address
First Line	:	540 E ARTESIA BLVD
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90805-1476
Country	:	US
Telephone Number	:	661-723-7416
Fax Number	:	661-723-9975

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

Provider Enumeration Date	:	07/13/2007
Last Update Date	:	03/24/2016

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