Individual
DR. LATISHA NICOLE SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
COMNAVSURFPAC, 2841 RENDOVA ROAD, SAN DIEGO, CA 92155-5490
(619) 556-8449
Mailing address
2170 BIRCH RD APT 110, CHULA VISTA, CA 91915-2034
(301) 300-1199
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
AP61318754
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1194352591
TRI-CARE
WA
Enumeration date
03/25/2020
Last updated
02/13/2025
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