Provider Demographics
NPI:1932824208
Name:SMITH, DORINDA A (MS IMMUNOTOXICOLOGY)
Entity Type:Individual
Prefix:
First Name:DORINDA
Middle Name:A
Last Name:SMITH
Suffix:
Gender:F
Credentials:MS IMMUNOTOXICOLOGY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27052 DEER CANYON DR
Mailing Address - Street 2:
Mailing Address - City:RAMONA
Mailing Address - State:CA
Mailing Address - Zip Code:92065-6708
Mailing Address - Country:US
Mailing Address - Phone:760-760-1890
Mailing Address - Fax:760-377-8697
Practice Address - Street 1:27052 DEER CANYON DR
Practice Address - Street 2:
Practice Address - City:RAMONA
Practice Address - State:CA
Practice Address - Zip Code:92065-6708
Practice Address - Country:US
Practice Address - Phone:760-315-1021
Practice Address - Fax:760-377-8697
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-07
Last Update Date:2022-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174H00000XOther Service ProvidersHealth EducatorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1234OtherNO INSURANCE OR OTHER IDENTIFIERS