Provider Demographics
NPI:1528683604
Name:HEALTHSMITH MEDICAL INC
Entity type:Organization
Organization Name:HEALTHSMITH MEDICAL INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:ANTONIO
Authorized Official - Middle Name:MARTN
Authorized Official - Last Name:OCANA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:604-803-8513
Mailing Address - Street 1:9808 VENICE BLVD PH
Mailing Address - Street 2:
Mailing Address - City:CULVER CITY
Mailing Address - State:CA
Mailing Address - Zip Code:90232-2732
Mailing Address - Country:US
Mailing Address - Phone:604-803-8513
Mailing Address - Fax:778-945-2778
Practice Address - Street 1:9808 VENICE BLVD PH
Practice Address - Street 2:
Practice Address - City:CULVER CITY
Practice Address - State:CA
Practice Address - Zip Code:90232-2732
Practice Address - Country:US
Practice Address - Phone:604-803-8513
Practice Address - Fax:778-945-2778
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-15
Last Update Date:2023-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA810150870Medicaid