Individual
MATTHEW J. SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
P.A.-C
Contact information
Practice address
22032 FRANK SINATRA DRIVE, SUITE 100, RANCHO MIRAGE, CA 92270
(760) 325-5588
(760) 322-7069
Mailing address
2285 CORPORATE CIR, STE 200, HENDERSON, NV 89074-7759
(702) 360-2763
(949) 783-2880
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA18314
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
P00346112
RAILROAD MEDICARE
CA
01
—
WPA18314A
INDIVIDUAL PTAN
CA
Enumeration date
06/06/2006
Last updated
07/06/2016
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