Individual
MS. TRACY MARIE SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
4190 CITY AVE, SUITE 528, PHILADELPHIA, PA 19131-1626
(866) 453-8800
(844) 734-7689
Mailing address
260 CALLE CAMPESINO, SAN CLEMENTE, CA 92672-4553
(949) 366-1053
(949) 544-7880
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
MA054091
PA
363AM0700X
Medical Physician Assistant
PA21436
CA
Other
Enumeration date
09/16/2009
Last updated
09/14/2015
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