Healthcare Provider Details

I. General information

NPI: 1982519823
Provider Name (Legal Business Name): DANIELE SMITH-MORTON DR. (EDD)
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/17/2026
Last Update Date: 08/17/2026
Certification Date: 08/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24300 CANYON LAKE DR N
CANYON LAKE CA
92587-8025
US

IV. Provider business mailing address

5443 TURIN WAY
FONTANA CA
92336-4615
US

V. Phone/Fax

Practice location:
  • Phone: 909-675-5007
  • Fax:
Mailing address:
  • Phone: 909-994-8795
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number331881765
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: