Individual
CHARLES E SMITH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
NURSE PRACTITIONER
Contact information
Practice address
15803 S MAPLE AVE, GARDENA, CA 90248-2534
(310) 918-4298
(310) 538-1650
Mailing address
15803 SOUTH MAPLE AVE, GARDENA, CA 90248
(310) 918-4298
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
95005523
CA
Other
Enumeration date
07/11/2013
Last updated
07/21/2022
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