Individual
MISS AUDREY ETTA SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
12311 VENTURA BLVD, STUDIO CITY, CA 91604-2509
(818) 762-1167
Mailing address
18560 VANOWEN ST UNIT 21, RESEDA, CA 91335-5307
(818) 632-1248
Taxonomy
Speciality
Code
Description
License number
State
363LP2300X
Primary Care Nurse Practitioner
Primary
95010044
CA
Other
Enumeration date
09/18/2018
Last updated
09/18/2018
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