Provider Demographics
NPI:1982840518
Name:REBECCA SMITH, MD, MEDICAL CORPORATION
Entity Type:Organization
Organization Name:REBECCA SMITH, MD, MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:RENEE
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:949-378-4987
Mailing Address - Street 1:272 SALINAS DR UNIT 165
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91914-0444
Mailing Address - Country:US
Mailing Address - Phone:619-482-3395
Mailing Address - Fax:619-482-3395
Practice Address - Street 1:272 SALINAS DR UNIT 165
Practice Address - Street 2:
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91914-0444
Practice Address - Country:US
Practice Address - Phone:619-482-3395
Practice Address - Fax:619-482-3395
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-03
Last Update Date:2009-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA98889207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAAT661ZMedicare PIN