Provider Demographics
NPI:1356512289
Name:SMITH, ELAINE LYNN (PA-C)
Entity Type:Individual
Prefix:
First Name:ELAINE
Middle Name:LYNN
Last Name:SMITH
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1318 E FLORENCE AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90001-1935
Mailing Address - Country:US
Mailing Address - Phone:323-584-9525
Mailing Address - Fax:323-583-6000
Practice Address - Street 1:15901 HAWTHORNE BLVD STE 250
Practice Address - Street 2:
Practice Address - City:LAWNDALE
Practice Address - State:CA
Practice Address - Zip Code:90260-2660
Practice Address - Country:US
Practice Address - Phone:310-679-0269
Practice Address - Fax:310-679-1038
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-19
Last Update Date:2023-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA14494363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical