Healthcare Provider Details

I. General information

NPI: 1992658926
Provider Name (Legal Business Name): HOSTEEN SMITH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/18/2026
Last Update Date: 02/18/2026
Certification Date: 02/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1833 W SOUTHERN AVE
MESA AZ
85202-4822
US

IV. Provider business mailing address

14435 S 48TH ST
PHOENIX AZ
85044-6427
US

V. Phone/Fax

Practice location:
  • Phone: 480-461-7000
  • Fax:
Mailing address:
  • Phone: 480-584-9384
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: