Individual
ERNEST CLARENCE KOANI SMITH JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
(IDC)
Contact information
Practice address
34101 FARENHOLT AVE BLDG 14, SAN DIEGO, CA 92134-4856
(808) 492-7003
Mailing address
34101 FARENHOLT AVE BLDG 14, SAN DIEGO, CA 92134-4856
(808) 492-7003
Taxonomy
Speciality
Code
Description
License number
State
1710I1002X
Independent Duty Corpsman
Primary
—
—
Other
Enumeration date
11/21/2023
Last updated
12/07/2023
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