1033644331 NPI number — GOLD STANDARD RECOVERY SERVICES, LLC

Table of content: BRIANNA NICOLE SMITH M.D. (NPI 1992117097)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033644331 NPI number — GOLD STANDARD RECOVERY SERVICES, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GOLD STANDARD RECOVERY SERVICES, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

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

NPI Number Information

NPI Number:
1033644331
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/22/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2319 WHITESANDS DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HUNTINGTON BEACH
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92648-2855
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
310-437-3114
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2319 WHITESANDS DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HUNTINGTON BEACH
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92648-2855
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-437-3114
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/24/2017

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
GUTHRIE
Authorized Official First Name:
CHELCIE
Authorized Official Middle Name:
R
Authorized Official Title or Position:
COO
Authorized Official Telephone Number:
657-464-0322

Provider Taxonomy Codes

  • Taxonomy code: 324500000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 324500000X , with the licence number: 300009AP , 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)