Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208800000X | Urologist | A112593 | CA |
NPI | 1063603108 |
---|---|
Provider Name | Damien L Smith |
First Address | Mountain View, CA 94040-6203 |
Second Address | Santa Cruz, CA 95065 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/08/2007 |
Last Update Date | 20/06/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1091430 | (05) | LA |
DV559V | MEDICARE (01) | CA |