Individual
TYLER SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
4505 S MARYLAND PKWY, LAS VEGAS, NV 89154-9900
(702) 895-3380
Mailing address
4209 FAIRFAX CIRCLE APT #2, LAS VEGAS, NV 89119
(909) 904-9130
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
20070700794501
IEHP
CA
Enumeration date
11/13/2017
Last updated
11/13/2017
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