Provider Demographics
NPI:1053898577
Name:SMITH, JOEL (RN, LAC)
Entity type:Individual
Prefix:
First Name:JOEL
Middle Name:
Last Name:SMITH
Suffix:
Gender:M
Credentials:RN, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2949 WALNUT BLVD
Mailing Address - Street 2:
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94596-4941
Mailing Address - Country:US
Mailing Address - Phone:510-610-3316
Mailing Address - Fax:
Practice Address - Street 1:2949 WALNUT BLVD
Practice Address - Street 2:
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94596-4941
Practice Address - Country:US
Practice Address - Phone:510-610-3316
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-26
Last Update Date:2018-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA458679163W00000X
CAAC17767171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No163W00000XNursing Service ProvidersRegistered Nurse