Provider Demographics
NPI:1528453537
Name:SMITH, NICOLE RENEE (MD)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:RENEE
Last Name:SMITH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2150 HILLHURST AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90027-2012
Mailing Address - Country:US
Mailing Address - Phone:909-323-2461
Mailing Address - Fax:803-590-6355
Practice Address - Street 1:2150 HILLHURST AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90027-2012
Practice Address - Country:US
Practice Address - Phone:909-323-2461
Practice Address - Fax:803-590-6355
Is Sole Proprietor?:No
Enumeration Date:2015-04-06
Last Update Date:2025-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCMD2100014412084P0800X
NY3068262084P0800X
MDD00856612084P0800X
CAA1851712084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry