Provider Demographics
NPI:1588836860
Name:SMITH, GRETCHEN DONNEL (MPPA)
Entity Type:Individual
Prefix:
First Name:GRETCHEN
Middle Name:DONNEL
Last Name:SMITH
Suffix:
Gender:F
Credentials:MPPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:415 W OCEAN BLVD
Mailing Address - Street 2:ROOM 100
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90802-4512
Mailing Address - Country:US
Mailing Address - Phone:562-491-5879
Mailing Address - Fax:562-435-8523
Practice Address - Street 1:415 W OCEAN BLVD
Practice Address - Street 2:ROOM 100
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90802-4512
Practice Address - Country:US
Practice Address - Phone:562-491-5879
Practice Address - Fax:562-435-8523
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-27
Last Update Date:2008-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator