Active NPI
Wayne Randolph Smith, HT
- Histology Technician
- Novato, CA
National Provider Identifier
1437644689
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Histology Technician
- License
- 25226
- Practice address
- 1615 Hill Rd Ste C
Novato, CA 94947-4338 - Phone
- (415) 209-6076
- NPI assigned
- Jun 28, 2018
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Histology Technician | 246RH0600X | 25226 | IL | Primary |
Addresses
Primary practice location
1615 Hill Rd Ste C
Novato, CA 94947-4338
Mailing address
9 Weybridge CT
Oakland, CA 94611-2749
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 25226 | IL | MD | Histology Technician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1530144000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1530144000000",
"number": "1437644689",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "9 WEYBRIDGE CT",
"city": "OAKLAND",
"state": "CA",
"postal_code": "946112749"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1615 HILL RD STE C",
"city": "NOVATO",
"state": "CA",
"postal_code": "949474338",
"telephone_number": "415-209-6076"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SMITH",
"first_name": "WAYNE",
"middle_name": "RANDOLPH",
"name_prefix": "Mr.",
"credential": "HT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2018-06-28",
"last_updated": "2018-06-28",
"status": "A"
},
"taxonomies": [
{
"code": "246RH0600X",
"taxonomy_group": "",
"desc": "Technician, Pathology, Histology",
"state": "IL",
"license": "25226",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Novato, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 28, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.