Individual
PHYLICIA SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
9500 ETIWANDA AVE, RANCHO CUCAMONGA, CA 91739-9662
(909) 463-5234
Mailing address
1330 E COOLEY DR, COLTON, CA 92324-3905
Taxonomy
Speciality
Code
Description
License number
State
167G00000X
Licensed Psychiatric Technician
Primary
PT 33961
CA
Other
Enumeration date
08/05/2013
Last updated
08/16/2013
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