Basic Information
| Provider Information | |||||||||
| NPI: | 1437334471 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SMITH | ||||||||
| FirstName: | LINDA | ||||||||
| MiddleName: | |||||||||
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| Credential: | RN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3125 E 7TH ST | ||||||||
| Address2: | |||||||||
| City: | LONG BEACH | ||||||||
| State: | CA | ||||||||
| PostalCode: | 908044932 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5624397755 | ||||||||
| FaxNumber: | 5624386891 | ||||||||
| Practice Location | |||||||||
| Address1: | 1500 HUGHES WAY | ||||||||
| Address2: | |||||||||
| City: | LONG BEACH | ||||||||
| State: | CA | ||||||||
| PostalCode: | 908101870 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3234895835 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/09/2008 | ||||||||
| LastUpdateDate: | 09/18/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/18/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | N | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | 163WA2000X | 313832 | CA | Y | Nursing Service Providers | Registered Nurse | Administrator |
ID Information
| ID | Type | State | Issuer | Description | 190077AHN | 05 | CA | MEDICAID |