Provider Demographics
NPI:1295100535
Name:SMITH, CAROL (DVM)
Entity type:Individual
Prefix:
First Name:CAROL
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:DVM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1312 SUNSET DR
Mailing Address - Street 2:
Mailing Address - City:ANTIOCH
Mailing Address - State:CA
Mailing Address - Zip Code:94509-2853
Mailing Address - Country:US
Mailing Address - Phone:925-754-5001
Mailing Address - Fax:
Practice Address - Street 1:1312 SUNSET DR
Practice Address - Street 2:
Practice Address - City:ANTIOCH
Practice Address - State:CA
Practice Address - Zip Code:94509-2853
Practice Address - Country:US
Practice Address - Phone:925-754-5001
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-12-12
Last Update Date:2015-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20963174M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174M00000XOther Service ProvidersVeterinarian