Provider Demographics
NPI:1235424219
Name:SMITH, CASEY MARIE (LAC, DIPL AC)
Entity Type:Individual
Prefix:
First Name:CASEY
Middle Name:MARIE
Last Name:SMITH
Suffix:
Gender:F
Credentials:LAC, DIPL AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10866 WASHINGTON BLVD.
Mailing Address - Street 2:#22
Mailing Address - City:CULVER CITY
Mailing Address - State:CA
Mailing Address - Zip Code:90232
Mailing Address - Country:US
Mailing Address - Phone:310-399-5388
Mailing Address - Fax:
Practice Address - Street 1:12114 VENICE BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90066-3812
Practice Address - Country:US
Practice Address - Phone:310-399-5388
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-17
Last Update Date:2021-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC-8303171100000X
NCC22627171100000X
CA8303171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist