Provider Demographics
NPI:1750651097
Name:SMITH, SHARLINA
Entity Type:Individual
Prefix:
First Name:SHARLINA
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:456 E NICOLET ST APT 905
Mailing Address - Street 2:
Mailing Address - City:BANNING
Mailing Address - State:CA
Mailing Address - Zip Code:92220-5673
Mailing Address - Country:US
Mailing Address - Phone:951-235-5271
Mailing Address - Fax:
Practice Address - Street 1:400 S EL CIELO RD SUITE E / F
Practice Address - Street 2:
Practice Address - City:PALM SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:92262-7926
Practice Address - Country:US
Practice Address - Phone:760-416-1753
Practice Address - Fax:760-416-0263
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-04
Last Update Date:2012-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator