Provider Demographics
NPI:1447493630
Name:SMITH, TRACY L (RD)
Entity type:Individual
Prefix:
First Name:TRACY
Middle Name:L
Last Name:SMITH
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2825 J ST
Mailing Address - Street 2:STE 435
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95816-4300
Mailing Address - Country:US
Mailing Address - Phone:916-978-0300
Mailing Address - Fax:916-978-0333
Practice Address - Street 1:2825 J ST
Practice Address - Street 2:STE 435
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95816-4300
Practice Address - Country:US
Practice Address - Phone:916-978-0300
Practice Address - Fax:916-978-0333
Is Sole Proprietor?:No
Enumeration Date:2009-04-17
Last Update Date:2010-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA723763133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered