Provider Demographics
NPI:1477731057
Name:SMITH, ROBERT KAREEM
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:KAREEM
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 1:2815 CAMINO DEL RIO S
Mailing Address - Street 2:SUITE 220
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92108-3815
Mailing Address - Country:US
Mailing Address - Phone:858-279-6772
Mailing Address - Fax:858-279-7505
Practice Address - Street 1:2815 CAMINO DEL RIO S
Practice Address - Street 2:SUITE 220
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-3815
Practice Address - Country:US
Practice Address - Phone:858-279-6772
Practice Address - Fax:858-279-7505
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-05
Last Update Date:2016-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAU2594231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist