Provider Demographics
NPI:1891721643
Name:SMITH, EVELYN MARIE (AUD, FAAA)
Entity Type:Individual
Prefix:DR
First Name:EVELYN
Middle Name:MARIE
Last Name:SMITH
Suffix:
Gender:F
Credentials:AUD, FAAA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4282 GENESEE AVE STE 301
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92117-4998
Mailing Address - Country:US
Mailing Address - Phone:858-279-3277
Mailing Address - Fax:858-279-3281
Practice Address - Street 1:4282 GENESEE AVE STE 301
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92117-4998
Practice Address - Country:US
Practice Address - Phone:858-279-3277
Practice Address - Fax:858-279-3281
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2008-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAU1781231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWAUD1291AMedicare UPIN