Provider Demographics
NPI:1285175786
Name:RENEE SMITH MD A PROFESSIONAL CORPORATION
Entity type:Organization
Organization Name:RENEE SMITH MD A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RENEE
Authorized Official - Middle Name:E
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:562-774-8074
Mailing Address - Street 1:10267 NEWVILLE AVE
Mailing Address - Street 2:
Mailing Address - City:DOWNEY
Mailing Address - State:CA
Mailing Address - Zip Code:90241-3036
Mailing Address - Country:US
Mailing Address - Phone:562-774-8074
Mailing Address - Fax:562-861-3075
Practice Address - Street 1:8301 FLORENCE AVE STE 301
Practice Address - Street 2:
Practice Address - City:DOWNEY
Practice Address - State:CA
Practice Address - Zip Code:90240-3948
Practice Address - Country:US
Practice Address - Phone:562-774-8074
Practice Address - Fax:562-861-3075
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-16
Last Update Date:2017-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG682982084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACB272475Medicare PIN