Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | DC 29575 | CA |
N | 111NN1001X | Nutrition | DC 29575 | CA |
NPI | 1659698868 |
---|---|
Provider Name | Dr. Angela M Smith |
First Address | Solana Beach, CA 92075-1238 |
Second Address | Solana Beach, CA 92075-1238 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/04/2010 |
Last Update Date | 27/04/2010 |