Provider Demographics
NPI:1023228673
Name:SMITH, SANDRA E
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:E
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:PO BOX 18961
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90018-0961
Mailing Address - Country:US
Mailing Address - Phone:323-632-6557
Mailing Address - Fax:323-735-8865
Practice Address - Street 1:3221 N ALAMEDA ST STE J
Practice Address - Street 2:
Practice Address - City:COMPTON
Practice Address - State:CA
Practice Address - Zip Code:90222-1440
Practice Address - Country:US
Practice Address - Phone:310-604-7751
Practice Address - Fax:310-635-7657
Is Sole Proprietor?:No
Enumeration Date:2007-05-23
Last Update Date:2025-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner