Provider Demographics
NPI:1396281606
Name:SMITH, MOYRA
Entity type:Individual
Prefix:PROF
First Name:MOYRA
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:
Other - Prefix:PROF
Other - First Name:MOYRA
Other - Middle Name:WRIGHT
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD PHD
Mailing Address - Street 1:2046 HEWITT HALL COLLEGE OF MEDICINE
Mailing Address - Street 2:HEALTH SCIENCES DRIVE, UNIVERSITY OF CALIFORNIA
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92697-0001
Mailing Address - Country:US
Mailing Address - Phone:949-824-0211
Mailing Address - Fax:
Practice Address - Street 1:333 THE CITY BLVD WEST
Practice Address - Street 2:SUITE 800
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868-4482
Practice Address - Country:US
Practice Address - Phone:714-456-8470
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-10
Last Update Date:2017-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA37841170100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170100000XOther Service ProvidersMedical Genetics, Ph.D. Medical Genetics