Provider Demographics
NPI:1164797478
Name:SMITH, CHRISTINA MARIA (CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:CHRISTINA
Middle Name:MARIA
Last Name:SMITH
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:MS
Other - First Name:CHRISTINA
Other - Middle Name:MARIA
Other - Last Name:LARIOS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CCC-SLP
Mailing Address - Street 1:13135 SUNNYBROOK CIR UNIT 102
Mailing Address - Street 2:
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92844-1282
Mailing Address - Country:US
Mailing Address - Phone:714-396-4749
Mailing Address - Fax:
Practice Address - Street 1:18726 S WESTERN AVE
Practice Address - Street 2:
Practice Address - City:GARDENA
Practice Address - State:CA
Practice Address - Zip Code:90248-3813
Practice Address - Country:US
Practice Address - Phone:310-352-6405
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-03-20
Last Update Date:2012-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA7448235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist