Provider Demographics
NPI:1669581518
Name:SMITH, ROBERT LAWRENCE (RN CCP)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:LAWRENCE
Last Name:SMITH
Suffix:
Gender:M
Credentials:RN CCP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1637 WRIGHT AVENUE
Mailing Address - Street 2:
Mailing Address - City:SUNNYVALE
Mailing Address - State:CA
Mailing Address - Zip Code:94087-5251
Mailing Address - Country:US
Mailing Address - Phone:408-737-8894
Mailing Address - Fax:408-737-8894
Practice Address - Street 1:1637 WRIGHT AVENUE
Practice Address - Street 2:
Practice Address - City:SUNNYVALE
Practice Address - State:CA
Practice Address - Zip Code:94087-5251
Practice Address - Country:US
Practice Address - Phone:408-737-8894
Practice Address - Fax:408-737-8894
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2007-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA283697174400000X
CA799111242T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes242T00000XTechnologists, Technicians & Other Technical Service ProvidersPerfusionist
No174400000XOther Service ProvidersSpecialist