Provider Demographics
NPI:1073972477
Name:SMITH, KRISTEN (RBT)
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1901 CARNEGIE AVE
Mailing Address - Street 2:SUITE 1-C
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92705-5504
Mailing Address - Country:US
Mailing Address - Phone:714-848-8319
Mailing Address - Fax:714-596-6274
Practice Address - Street 1:1901 CARNEGIE AVE
Practice Address - Street 2:SUITE 1-C
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92705-5504
Practice Address - Country:US
Practice Address - Phone:714-848-8319
Practice Address - Fax:714-596-6274
Is Sole Proprietor?:No
Enumeration Date:2016-02-15
Last Update Date:2016-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARBT-16-15952247200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other