Provider Demographics
NPI:1700445699
Name:SMITH, ALLISON M (PA-C)
Entity Type:Individual
Prefix:
First Name:ALLISON
Middle Name:M
Last Name:SMITH
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
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Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:253 N MAR VISTA AVE APT 8
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91106-1417
Mailing Address - Country:US
Mailing Address - Phone:951-205-8137
Mailing Address - Fax:
Practice Address - Street 1:18520 VIA PRINCESSA
Practice Address - Street 2:
Practice Address - City:CANYON COUNTRY
Practice Address - State:CA
Practice Address - Zip Code:91387-8326
Practice Address - Country:US
Practice Address - Phone:661-424-9000
Practice Address - Fax:661-424-0808
Is Sole Proprietor?:No
Enumeration Date:2019-06-13
Last Update Date:2021-12-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA56867363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant