Provider Demographics
NPI:1558712778
Name:SMITH, ALEXIS NICOLE (MD)
Entity Type:Individual
Prefix:DR
First Name:ALEXIS
Middle Name:NICOLE
Last Name:SMITH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10953 RAMONA BLVD
Mailing Address - Street 2:
Mailing Address - City:EL MONTE
Mailing Address - State:CA
Mailing Address - Zip Code:91731-2629
Mailing Address - Country:US
Mailing Address - Phone:626-434-2500
Mailing Address - Fax:626-279-9064
Practice Address - Street 1:10953 RAMONA BLVD
Practice Address - Street 2:
Practice Address - City:EL MONTE
Practice Address - State:CA
Practice Address - Zip Code:91731-2629
Practice Address - Country:US
Practice Address - Phone:626-434-2500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-29
Last Update Date:2020-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA151910207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine