Kiersten M Smith, RADT

Primary specialty

Substance Abuse Rehabilitation FacilityTaxonomy code 324500000X

License

R1364550919 Issued in CA

Practice address

808 Amador CT
Lake Elsinore, CA 92530-1862

Phone

(714) 331-5554

NPI assigned

May 5, 2020

Sex

Female

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": "1588636800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1588636800000",
    "number": "1588285134",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "808 AMADOR CT",
            "city": "LAKE ELSINORE",
            "state": "CA",
            "postal_code": "925301862",
            "telephone_number": "714-331-5554"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "808 AMADOR CT",
            "city": "LAKE ELSINORE",
            "state": "CA",
            "postal_code": "925301862",
            "telephone_number": "714-331-5554"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SMITH",
        "first_name": "KIERSTEN",
        "middle_name": "M",
        "name_prefix": "Ms.",
        "credential": "RADT",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-05-05",
        "last_updated": "2020-05-05",
        "certification_date": "2020-05-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "324500000X",
            "taxonomy_group": "",
            "desc": "Substance Abuse Rehabilitation Facility",
            "state": "CA",
            "license": "R1364550919",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Betsy Silva
• Marcilla Silva
• Anita C Singh, D.D.S.
• Gurpreet Singh
• Kristina Louise Sisco
• Melony Smith, LVN
• Jonathan Michael Snipes, M.D.
• Socal Ritual Bodywork
• Socaltech Systems Inc.
• Soheil Pishgar Levi DDS Inc

• Substance Abuse Rehabilitation Facility in Lake Elsinore, CA
• Providers in Lake Elsinore, CA by specialty
• Substance Abuse Rehabilitation Facility in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 5, 2020; 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.