Provider Demographics
NPI:1093330557
Name:SMITH, LAURA H (RD)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:H
Last Name:SMITH
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3661 1ST AVE
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95817-2001
Mailing Address - Country:US
Mailing Address - Phone:510-387-5166
Mailing Address - Fax:
Practice Address - Street 1:9821 FAIR OAKS BLVD STE B
Practice Address - Street 2:
Practice Address - City:FAIR OAKS
Practice Address - State:CA
Practice Address - Zip Code:95628-7050
Practice Address - Country:US
Practice Address - Phone:916-520-6886
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-10
Last Update Date:2020-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered