Provider Demographics
NPI:1467650093
Name:SMITH, MYRON ANTHONY
Entity Type:Individual
Prefix:
First Name:MYRON
Middle Name:ANTHONY
Last Name:SMITH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4151 3RD AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90008-4050
Mailing Address - Country:US
Mailing Address - Phone:323-971-9000
Mailing Address - Fax:323-971-9474
Practice Address - Street 1:5701 S FIGUEROA ST
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90037-4039
Practice Address - Country:US
Practice Address - Phone:323-971-9000
Practice Address - Fax:323-971-9474
Is Sole Proprietor?:No
Enumeration Date:2007-07-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator