Individual
SUSAN MARIE SMITH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
1300 W 7TH ST, SAN PEDRO, CA 90732-3505
(310) 241-4022
Mailing address
1300 W 7TH ST, SAN PEDRO, CA 90732-3505
(310) 241-4022
Taxonomy
Speciality
Code
Description
License number
State
163WP0808X
Psychiatric/Mental Health Registered Nurse
Primary
303119
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
7255506
PROVIDENCE LITTLE COMPANY OF MARY SAN PEDRO
CA
Enumeration date
11/19/2019
Last updated
11/19/2019
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