Provider Demographics
NPI:1457085706
Name:SMITH, ANTHONY (LVN)
Entity Type:Individual
Prefix:MR
First Name:ANTHONY
Middle Name:
Last Name:SMITH
Suffix:
Gender:M
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37141 ALMOND CIR
Mailing Address - Street 2:
Mailing Address - City:MURRIETA
Mailing Address - State:CA
Mailing Address - Zip Code:92563-3252
Mailing Address - Country:US
Mailing Address - Phone:951-809-9137
Mailing Address - Fax:
Practice Address - Street 1:37141 ALMOND CIR
Practice Address - Street 2:
Practice Address - City:MURRIETA
Practice Address - State:CA
Practice Address - Zip Code:92563-3252
Practice Address - Country:US
Practice Address - Phone:951-809-9137
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-13
Last Update Date:2022-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA268266164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes164X00000XNursing Service ProvidersLicensed Vocational NurseGroup - Single Specialty