Individual
MR. WILLIE SMITH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1265 N CAPITOL AVE APT 90, SAN JOSE, CA 95132-2546
(408) 886-8070
Mailing address
1265 N CAPITOL AVE APT 90, SAN JOSE, CA 95132-2546
(408) 886-8070
Taxonomy
Speciality
Code
Description
License number
State
172A00000X
Driver
Primary
A4709810
CA
Other
Enumeration date
08/30/2021
Last updated
08/30/2021
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