Individual
OLIVIA CARMEN SMITH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
ATC
Contact information
Practice address
2439 COUNTRY CLUB DR, GLENDORA, CA 91741-4009
(949) 525-7601
Mailing address
2439 COUNTRY CLUB DR, GLENDORA, CA 91741-4009
(949) 525-7601
Taxonomy
Speciality
Code
Description
License number
State
2081S0010X
Sports Medicine (Physical Medicine & Rehabilitation) Physician
Primary
0506532
NV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0506532
NEVADA STATE BOARD OF ATHLETIC TRAINERS
NV
01
—
2000025843
NATA/BOC
CA
Enumeration date
10/01/2019
Last updated
10/01/2019
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