1265523112 NPI number — KAREN L. GLANCE-SMITH CRNA

Table of content: KAREN L. GLANCE-SMITH CRNA (NPI 1265523112)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265523112 NPI number — KAREN L. GLANCE-SMITH CRNA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GLANCE-SMITH
Provider First Name:
KAREN
Provider Middle Name:
L.
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
CRNA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
GLANCE
Provider Other First Name:
KAREN
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1265523112
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/18/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3050 E AIRPORT WAY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LONG BEACH
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90806-2404
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
562-426-9661
Provider Business Mailing Address Fax Number:
562-426-4227

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8635 FIRESTONE BLVD
Provider Second Line Business Practice Location Address:
STE # 100
Provider Business Practice Location Address City Name:
DOWNEY
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90241-5242
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
562-862-5121
Provider Business Practice Location Address Fax Number:
562-862-3027
Provider Enumeration Date:
09/27/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 367500000X , with the licence number:  2582 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: RN5614700 . This is a "MEDI-CAL" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com