Individual
MS. ROBERTA JEAN SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
C.PED
Contact information
Practice address
801 DOLLIVER ST, PISMO BEACH, CA 93449-2503
(805) 773-5571
(805) 773-1270
Mailing address
801 DOLLIVER, PISMO BEACH, CA 93449
(805) 773-5571
(805) 773-1270
Taxonomy
Speciality
Code
Description
License number
State
224L00000X
Pedorthist
Primary
CPED3993
CA
Other
Enumeration date
06/15/2017
Last updated
07/21/2022
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