Sean Arthur Smith

Primary specialty

Licensed Vocational NurseTaxonomy code 164X00000X

License

689343 Issued in CA

Practice address

11962 Woodside Ave
Lakeside, CA 92040-2914

Phone

(619) 561-1222

Fax

(619) 390-9487

NPI assigned

Feb 3, 2020

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1580688000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1672876800000",
    "number": "1477184919",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11962 WOODSIDE AVE",
            "city": "LAKESIDE",
            "state": "CA",
            "postal_code": "920402914",
            "telephone_number": "619-561-1222",
            "fax_number": "619-390-8663"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11962 WOODSIDE AVE",
            "city": "LAKESIDE",
            "state": "CA",
            "postal_code": "920402914",
            "telephone_number": "619-561-1222",
            "fax_number": "619-390-9487"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "6160 Mission Gorge Rd",
            "address_purpose": "LOCATION",
            "city": "San Diego",
            "state": "CA",
            "postal_code": "921203410",
            "country_code": "US",
            "telephone_number": "619-481-3790",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SMITH",
        "first_name": "SEAN",
        "middle_name": "ARTHUR",
        "name_prefix": "Mr.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2020-02-03",
        "last_updated": "2023-01-05",
        "certification_date": "2023-01-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "164X00000X",
            "taxonomy_group": "",
            "desc": "Licensed Vocational Nurse",
            "state": "CA",
            "license": "689343",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Licensed Vocational Nurse in Lakeside, CA
• Providers in Lakeside, CA by specialty
• Licensed Vocational Nurse in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 5, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.