Smith, Collis
Smith, Collis is an individual health care provider with primary practice located at 2080 S E St , San Bernardino CA 92408-2706. He recently has only one registered license in Nursing Service Providers / Licensed Psychiatric Technician, which is considered as his primary health care specialty. Smith, Collis can be contacted via phone (909) 825-8989.Contact Information
Primary practice address
2080 S E St
San Bernardino CA 92408-2706
Phone: (909) 825-8989
Fax:
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Nursing Service Providers / Licensed Psychiatric Technician | 167G00000X | 34214 | California |
Profile Details
| NPI number | 1184959173 |
|---|---|
| LBN Legal business name | Smith, Collis |
| Credentials | |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Oct 8th, 2009 |
| Last updated | Oct 8th, 2009 - about 16 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1184959173 | NPPES |
| California | MEDICAID | 1124100383 |
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