Provider Demographics
NPI:1245373109
Name:STEWART SMITH, LATISHA ANN (NURSE PRACTTIONER)
Entity type:Individual
Prefix:MRS
First Name:LATISHA
Middle Name:ANN
Last Name:STEWART SMITH
Suffix:
Gender:F
Credentials:NURSE PRACTTIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:1950 MENTONE AVE
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91103-1429
Mailing Address - Country:US
Mailing Address - Phone:626-797-9574
Mailing Address - Fax:626-797-9558
Practice Address - Street 1:14445 OLIVE VIEW DR
Practice Address - Street 2:
Practice Address - City:SYLMAR
Practice Address - State:CA
Practice Address - Zip Code:91342-1437
Practice Address - Country:US
Practice Address - Phone:818-364-3163
Practice Address - Fax:818-364-3383
Is Sole Proprietor?:No
Enumeration Date:2007-02-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA370062363LW0102X, 363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Not Answered363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology