Provider Demographics
NPI:1043045370
Name:SMITH, GARRETT RYAN (CPT)
Entity type:Individual
Prefix:
First Name:GARRETT
Middle Name:RYAN
Last Name:SMITH
Suffix:
Gender:M
Credentials:CPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1428 VIA GALICIA
Mailing Address - Street 2:
Mailing Address - City:PLS VRDS EST
Mailing Address - State:CA
Mailing Address - Zip Code:90274-2865
Mailing Address - Country:US
Mailing Address - Phone:310-719-5265
Mailing Address - Fax:
Practice Address - Street 1:1428 VIA GALICIA
Practice Address - Street 2:
Practice Address - City:PLS VRDS EST
Practice Address - State:CA
Practice Address - Zip Code:90274-2865
Practice Address - Country:US
Practice Address - Phone:310-719-5265
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-05
Last Update Date:2024-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes173000000XOther Service ProvidersLegal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA02410076OtherUNITED STATES DEPARTMENT HEALTH AND HUMAN SERVICES