Provider Demographics
NPI:1013950443
Name:SMITH, YNOLDE FAUSTINA (DO)
Entity Type:Individual
Prefix:
First Name:YNOLDE
Middle Name:FAUSTINA
Last Name:SMITH
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:279 IMPERIAL HWY
Mailing Address - Street 2:SUITE 730
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92835-1041
Mailing Address - Country:US
Mailing Address - Phone:714-449-4841
Mailing Address - Fax:714-449-4956
Practice Address - Street 1:2151 N HARBOR BLVD
Practice Address - Street 2:SUITE 3200
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92835-3820
Practice Address - Country:US
Practice Address - Phone:714-446-5101
Practice Address - Fax:714-871-3006
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A9284207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CABS9395333OtherDEA
CADQ735ZMedicare PIN