Provider Demographics
NPI:1952964959
Name:SMITH, AARENTINO (FNP-C)
Entity Type:Individual
Prefix:
First Name:AARENTINO
Middle Name:
Last Name:SMITH
Suffix:
Gender:M
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25800 INDUSTRIAL BLVD APT Z1205
Mailing Address - Street 2:
Mailing Address - City:HAYWARD
Mailing Address - State:CA
Mailing Address - Zip Code:94545-2935
Mailing Address - Country:US
Mailing Address - Phone:408-770-0986
Mailing Address - Fax:510-981-4291
Practice Address - Street 1:837 ADDISON STREET
Practice Address - Street 2:
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94710
Practice Address - Country:US
Practice Address - Phone:510-981-4100
Practice Address - Fax:510-981-4291
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-16
Last Update Date:2020-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95011329363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily