Provider Demographics
NPI:1679227326
Name:SMART HEALTH & WELLNESS
Entity Type:Organization
Organization Name:SMART HEALTH & WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO & PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:RAYMOND
Authorized Official - Middle Name:BENJAMIN
Authorized Official - Last Name:RAVEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-579-2362
Mailing Address - Street 1:27372 ALISO CREEK RD STE 200
Mailing Address - Street 2:
Mailing Address - City:ALISO VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92656-5339
Mailing Address - Country:US
Mailing Address - Phone:818-579-2362
Mailing Address - Fax:818-579-2377
Practice Address - Street 1:27372 ALISO CREEK RD STE 200
Practice Address - Street 2:
Practice Address - City:ALISO VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92656-5339
Practice Address - Country:US
Practice Address - Phone:949-520-1012
Practice Address - Fax:949-520-1045
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-10
Last Update Date:2023-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
No207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand SurgeryGroup - Multi-Specialty
No207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports MedicineGroup - Multi-Specialty