Provider Demographics
NPI:1255664538
Name:SMILO MEDICAL ASSOCIATES INC
Entity Type:Organization
Organization Name:SMILO MEDICAL ASSOCIATES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RENATA
Authorized Official - Middle Name:P
Authorized Official - Last Name:SMILO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:415-345-8075
Mailing Address - Street 1:3580 CALIFORNIA ST STE 302
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94118-1715
Mailing Address - Country:US
Mailing Address - Phone:415-345-8075
Mailing Address - Fax:415-929-1307
Practice Address - Street 1:3580 CALIFORNIA STREET
Practice Address - Street 2:SUITE 302
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94118
Practice Address - Country:US
Practice Address - Phone:415-345-8075
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-17
Last Update Date:2010-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA18898207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CANPI 1255664538OtherPTAN CR655A