Doctor Name: | KRISTA SMITH |
NPI Number: | 1013335587 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | |
License Number: | 95000130 |
Business Practice Address: | 11201 Benton St Loma Linda, CA - 923571000 |
Business Phone Number: | 9098257084 |
Business Fax Number: | |
Mailing Address: | 11201 Benton St, LOMA LINDA |
State: | CA |
Postal Code: | 923571000 |
Phone Number: | 9098257084 |
Fax Number: | |
NPI Enumeration Date: | 04/02/2014 |
NPI Last Update Date: | 04/02/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | 95000130 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | CA |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |