Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207QA0401X | Family Doctor - Addiction Medicine | G61164 | CA |
Y | 207RA0401X | Internist - Addiction Medicine | G61164 | CA |
N | 208200000X | Surgeon | G61164 | CA |
N | 208600000X | Surgeon | G61164 | CA |
NPI | 1023049483 |
---|---|
Provider Name | Dr. Craig V Smith |
First Address | Los Angeles, CA 90018-1529 |
Second Address | Malibu, CA 90265-4825 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/07/2006 |
Last Update Date | 11/10/2018 |