Provider Demographics
NPI:1497418362
Name:SMITH, TICAL LALELIA YVETTE
Entity Type:Individual
Prefix:
First Name:TICAL
Middle Name:LALELIA YVETTE
Last Name:SMITH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:430 SW 13TH AVE APT 1904
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97205-2373
Mailing Address - Country:US
Mailing Address - Phone:503-737-7627
Mailing Address - Fax:
Practice Address - Street 1:430 SW 13TH AVE APT 1904
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97205-2373
Practice Address - Country:US
Practice Address - Phone:503-737-7627
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-18
Last Update Date:2021-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula