Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101Y00000X | Counselor |
NPI | 1003147398 |
---|---|
Provider Name | Domeiqua D Smoot |
First Address | Rancho Cucamonga, CA 91730-5807 |
Second Address | Rancho Cucamonga, CA 91730-5807 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/01/2010 |
Last Update Date | 26/07/2013 |