Provider Information for 1932635158
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MYKAYLA SMITH
Sex: Female
NPI: 1932635158
Last Updated: 2024-06-29
Certification Date: 2024-06-29
Certification Date: 2024-06-29
Details
| Name | Value | ||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| NPI | 1932635158 | ||||||||||||
| Enumeration Date | 2017-05-08 | ||||||||||||
| NPI Type | NPI-1 Individual | ||||||||||||
| Sole Proprietor | NO | ||||||||||||
| Status | Active | ||||||||||||
| Mailing Address | 2178 JOHNSON AVE SAN LUIS OBISPO, CA 93401-4535 United States Phone: 805-781-4806 | Fax: | ||||||||||||
| Primary Practice Address | 2178 JOHNSON AVE SAN LUIS OBISPO, CA 93401-4535 United States Phone: 805-781-4806 | Fax: | ||||||||||||
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