Provider Demographics
NPI:1962601500
Name:GREEN-SMITH, LATOYA ANDRECIA (MD)
Entity type:Individual
Prefix:
First Name:LATOYA
Middle Name:ANDRECIA
Last Name:GREEN-SMITH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6501 GARFIELD AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:BELL GARDENS
Mailing Address - State:CA
Mailing Address - Zip Code:90201-1805
Mailing Address - Country:US
Mailing Address - Phone:562-499-6191
Mailing Address - Fax:562-499-6171
Practice Address - Street 1:540 E ARTESIA BLVD
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90805-1476
Practice Address - Country:US
Practice Address - Phone:661-723-7416
Practice Address - Fax:661-723-9975
Is Sole Proprietor?:No
Enumeration Date:2007-07-13
Last Update Date:2016-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA111079208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADO288ZMedicare PIN
CADO288XMedicare PIN
CADO288YMedicare UPIN
CADO288UMedicare PIN
CADO288WMedicare PIN
CADO288VMedicare PIN