Provider Demographics
NPI:1609055607
Name:SMITH, WAYNE CHRISTOPHER (RN)
Entity Type:Individual
Prefix:MR
First Name:WAYNE
Middle Name:CHRISTOPHER
Last Name:SMITH
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:229 20TH ST
Mailing Address - Street 2:APT.C
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92102-3845
Mailing Address - Country:US
Mailing Address - Phone:619-546-7927
Mailing Address - Fax:619-546-7927
Practice Address - Street 1:229 20TH ST
Practice Address - Street 2:APT.C
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92102-3845
Practice Address - Country:US
Practice Address - Phone:619-546-7927
Practice Address - Fax:619-546-7927
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-26
Last Update Date:2015-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA534727163W00000X
CADC15629111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No163W00000XNursing Service ProvidersRegistered Nurse