Clement Gustavous Smith, Caregiver
Adult Companion in Port Charlotte, FL. Individual provider (NPI-1).
NPI number1023362373
StatusActive
Last updated in NPPESNov 7, 2012
Details
- NPI
- 1023362373
- Entity type
- Individual (NPI-1)
- Name
- Mr. Clement Gustavous Smith
- Credential
- Caregiver
- Sex
- Male
- Sole proprietor
- Yes
- Enumeration date
- Nov 7, 2012
- Last updated
- Nov 7, 2012
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 372600000X | Adult Companion | – | – | Yes |
Practice location
3081 Jody StreetPort Charlotte, FL 33948
Phone 941-764-7461 · Fax 941-764-7461
Mailing address
3081 Jody StreetPort Charlotte, FL 33948
Phone 941-764-7461 · Fax 941-764-7461
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