Provider Demographics
NPI:1922749480
Name:SMITH, NAOMI SKY
Entity Type:Individual
Prefix:
First Name:NAOMI
Middle Name:SKY
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 1:1824 VIOLA PL # B
Mailing Address - Street 2:
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92627-2725
Mailing Address - Country:US
Mailing Address - Phone:951-221-2153
Mailing Address - Fax:
Practice Address - Street 1:1824 VIOLA PL # B
Practice Address - Street 2:
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92627-2725
Practice Address - Country:US
Practice Address - Phone:951-221-2153
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-06
Last Update Date:2022-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes376J00000XNursing Service Related ProvidersHomemakerGroup - Multi-Specialty