Individual
DUSTY JOE SMITH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
A.T.C.
Contact information
Practice address
100 S BARRINGTON PL, LOS ANGELES, CA 90049-3306
(310) 889-2794
Mailing address
1328 19TH ST APT A, SANTA MONICA, CA 90404-1926
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
—
CA
Other
Enumeration date
04/18/2007
Last updated
07/08/2007
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