Provider Demographics
NPI:1780838730
Name:SMITH, EVETTE DELPHINE (LMT)
Entity Type:Individual
Prefix:MS
First Name:EVETTE
Middle Name:DELPHINE
Last Name:SMITH
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9616 WALNUT AVE
Mailing Address - Street 2:
Mailing Address - City:ELK GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:95624-2324
Mailing Address - Country:US
Mailing Address - Phone:916-686-1873
Mailing Address - Fax:916-686-1874
Practice Address - Street 1:9616 WALNUT AVE
Practice Address - Street 2:
Practice Address - City:ELK GROVE
Practice Address - State:CA
Practice Address - Zip Code:95624-2324
Practice Address - Country:US
Practice Address - Phone:916-686-1873
Practice Address - Fax:916-686-1874
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-04
Last Update Date:2008-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA09-00006251225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist