Individual
MRS. NICOLE ANNETTE SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
7777 B MILLIKEN AVE ST 240, RANCHO CUCAMONGA, CA 91730
(909) 941-0247
Mailing address
1542 LA COSTA CIR, UPLAND, CA 91784-8047
(909) 931-1553
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA 17734
CA
Other
Enumeration date
03/07/2007
Last updated
07/08/2007
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