Provider Demographics
NPI:1609941632
Name:SMITH, RAYMOND N (FNP)
Entity Type:Individual
Prefix:MR
First Name:RAYMOND
Middle Name:N
Last Name:SMITH
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:840 TOWNE CENTER DR
Mailing Address - Street 2:
Mailing Address - City:POMONA
Mailing Address - State:CA
Mailing Address - Zip Code:91767-5900
Mailing Address - Country:US
Mailing Address - Phone:909-398-1500
Mailing Address - Fax:909-398-1573
Practice Address - Street 1:160 E ARTESIA ST
Practice Address - Street 2:SUITE 220
Practice Address - City:POMONA
Practice Address - State:CA
Practice Address - Zip Code:91767-2900
Practice Address - Country:US
Practice Address - Phone:909-865-1020
Practice Address - Fax:909-865-1202
Is Sole Proprietor?:No
Enumeration Date:2006-11-22
Last Update Date:2015-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA14029363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CARN399918Medicaid
CAEW603YMedicare PIN
CARN399918Medicaid