Roberta Jean Smith, C.PED

Primary specialty

PedorthistTaxonomy code 224L00000X

License

CPED3993 Issued in CA

Practice address

801 Dolliver St
Pismo Beach, CA 93449-2503

Phone

(805) 773-5571

Fax

(805) 773-1270

NPI assigned

Jun 15, 2017

Last updated

Jul 21, 2022By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Dolliver Tree, Inc.

  dba The Shoe Tree

  • Prosthetic/Orthotic Supplier
  • Pismo Beach, CA
  • NPI 1467889121
  NPD (past)
• The Shoe Tree, Inc

  • Prosthetic/Orthotic Supplier
  • Pismo Beach, CA
  • NPI 1801822937
  NPD (past)

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

{
    "created_epoch": "1497484800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1487184123",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "801 DOLLIVER",
            "city": "PISMO BEACH",
            "state": "CA",
            "postal_code": "93449",
            "telephone_number": "805-773-5571",
            "fax_number": "805-773-1270"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "801 DOLLIVER ST",
            "city": "PISMO BEACH",
            "state": "CA",
            "postal_code": "934492503",
            "telephone_number": "805-773-5571",
            "fax_number": "805-773-1270"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SMITH",
        "first_name": "ROBERTA",
        "middle_name": "JEAN",
        "name_prefix": "Ms.",
        "credential": "C.PED",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-06-15",
        "last_updated": "2022-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "224L00000X",
            "taxonomy_group": "",
            "desc": "Pedorthist",
            "state": "CA",
            "license": "CPED3993",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Nicole Lynn Simental, RN- BSN FNP
• James Robert Skow, M.D., F.A.C.S.
• Slo Psychological Services (SLO Psych Services)
• Johann Smit
• Alana Smith-Grove, LMFT
• Patrick Jackson Spalding, MD
• Kaitlin Spangler, CNM
• Spearman MD Inc. (Central Coast Vein& Vascular)
• Paul T Stallman, MD
• Heather Dawn Stanley-Carter, MS

• Pedorthist in Pismo Beach, CA
• Providers in Pismo Beach, CA by specialty
• Pedorthist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; 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.