Provider Demographics
NPI:1710030812
Name:SMITH, RENEE ELENA (MD)
Entity Type:Individual
Prefix:DR
First Name:RENEE
Middle Name:ELENA
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 1:10267 NEWVILLE AVE
Mailing Address - Street 2:
Mailing Address - City:DOWNEY
Mailing Address - State:CA
Mailing Address - Zip Code:90241-3036
Mailing Address - Country:US
Mailing Address - Phone:562-862-0604
Mailing Address - Fax:562-861-3075
Practice Address - Street 1:8301 FLORENCE AVE STE 301
Practice Address - Street 2:
Practice Address - City:DOWNEY
Practice Address - State:CA
Practice Address - Zip Code:90240-3948
Practice Address - Country:US
Practice Address - Phone:562-862-0604
Practice Address - Fax:562-861-3075
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-19
Last Update Date:2015-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG682982084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G682982Medicaid
CAE95397Medicare UPIN
CAG68298CMedicare PIN