Provider Demographics
NPI:1245838879
Name:SMITH, LALAINE TALAGTAG (FNP-C)
Entity type:Individual
Prefix:MRS
First Name:LALAINE
Middle Name:TALAGTAG
Last Name:SMITH
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:919 MARINER DR APT C
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN VIEW
Mailing Address - State:CA
Mailing Address - Zip Code:94043-3372
Mailing Address - Country:US
Mailing Address - Phone:386-871-8291
Mailing Address - Fax:
Practice Address - Street 1:919 MARINER DR APT C
Practice Address - Street 2:
Practice Address - City:MOUNTAIN VIEW
Practice Address - State:CA
Practice Address - Zip Code:94043-3372
Practice Address - Country:US
Practice Address - Phone:386-871-8291
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-15
Last Update Date:2020-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11008506207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine