Individual
SHANTANECE SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
43909 30TH ST W, LANCASTER, CA 93536-5843
(661) 802-2728
Mailing address
43909 30TH ST W, LANCASTER, CA 93536-5843
(661) 802-2728
Taxonomy
Speciality
Code
Description
License number
State
225500000X
Respiratory/Developmental/Rehabilitative Specialist/Technologist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
E1619460
DEPARTMENT OF MOTOR VEHICLES
CA
Enumeration date
10/31/2018
Last updated
10/31/2018
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