Provider Demographics
NPI:1255050688
Name:SMITH, CHRISALINE
Entity type:Individual
Prefix:
First Name:CHRISALINE
Middle Name:
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 1:51 CAROL LN APT 110
Mailing Address - Street 2:
Mailing Address - City:OAKLEY
Mailing Address - State:CA
Mailing Address - Zip Code:94561-4479
Mailing Address - Country:US
Mailing Address - Phone:925-565-2324
Mailing Address - Fax:
Practice Address - Street 1:51 CAROL LN APT 110
Practice Address - Street 2:
Practice Address - City:OAKLEY
Practice Address - State:CA
Practice Address - Zip Code:94561-4479
Practice Address - Country:US
Practice Address - Phone:925-565-2324
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-29
Last Update Date:2022-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes342000000XTransportation ServicesTransportation Network Company