Healthcare Provider Details

I. General information

NPI: 1467647032
Provider Name (Legal Business Name): DOLORES INEZ SMITH SLPA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DOLORES INEZ AYALA

II. Dates (important events)

Enumeration Date: 09/07/2007
Last Update Date: 09/07/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 SCHOOL DR
HUACHUCA CITY AZ
85638
US

IV. Provider business mailing address

PO BOX 1000
TOMBSTONE AZ
85638
US

V. Phone/Fax

Practice location:
  • Phone: 520-456-9842
  • Fax: 520-456-9811
Mailing address:
  • Phone: 520-457-2217
  • Fax: 520-457-3270

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: