Individual
MR. CLEMENT GUSTAVOUS SMITH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CAREGIVER
Contact information
Practice address
3081 JODY STREET, PORT CHARLOTTE, FL 33948
(941) 764-7461
(941) 764-7461
Mailing address
3081 JODY STREET, PORT CHARLOTTE, FL 33948
(941) 764-7461
(941) 764-7461
Taxonomy
Speciality
Code
Description
License number
State
372600000X
Adult Companion
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000957800
—
FL
Enumeration date
11/07/2012
Last updated
11/07/2012
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