Healthcare Provider Details

I. General information

NPI: 1427781954
Provider Name (Legal Business Name): DOMINIC SMOTHERS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/01/2022
Last Update Date: 09/08/2026
Certification Date: 09/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 E FLORIDA AVE
HEMET CA
92544-4679
US

IV. Provider business mailing address

PO BOX 2686
HEMET CA
92546-2686
US

V. Phone/Fax

Practice location:
  • Phone: 951-357-6959
  • Fax:
Mailing address:
  • Phone: 951-357-6959
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-26-2846763
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-22-241911
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: