Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208800000X | Urologist | A172902 | CA |
NPI | 1043673791 |
---|---|
Provider Name | Dr. Shannon Marie Smith |
First Address | Torrance, CA 90504-5513 |
Second Address | West Hollywood, CA 90048-1804 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/03/2016 |
Last Update Date | 05/08/2021 |