Provider Demographics
NPI:1144934902
Name:SMITH, ARMANDA ESTELLE
Entity type:Individual
Prefix:
First Name:ARMANDA
Middle Name:ESTELLE
Last Name:SMITH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12150 PIGEON PASS RD # II276
Mailing Address - Street 2:
Mailing Address - City:MORENO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92557-6967
Mailing Address - Country:US
Mailing Address - Phone:951-476-7215
Mailing Address - Fax:
Practice Address - Street 1:12150 PIGEON PASS RD # II276
Practice Address - Street 2:
Practice Address - City:MORENO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92557-6967
Practice Address - Country:US
Practice Address - Phone:562-326-7974
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-06
Last Update Date:2023-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver