Healthcare Provider Details

I. General information

NPI: 1861255770
Provider Name (Legal Business Name): PATRICIA ANN SMILEY PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/02/2024
Last Update Date: 07/17/2026
Certification Date: 07/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

405 N INDIAN HILL BLVD
CLAREMONT CA
91711-4614
US

IV. Provider business mailing address

405 N INDIAN HILL BLVD
CLAREMONT CA
91711-4614
US

V. Phone/Fax

Practice location:
  • Phone: 949-229-5708
  • Fax:
Mailing address:
  • Phone: 949-229-5708
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number36743
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: