Healthcare Provider Details

I. General information

NPI: 1225202021
Provider Name (Legal Business Name): JAMES CAMERON SMITH CADC-II
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/14/2008
Last Update Date: 04/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4070 CALIFORNIA OAKS RD SUITE 202
MURRIETA CA
92562
US

IV. Provider business mailing address

4070 CALIFORNIA OAKS RD SUITE 202
MURRIETA CA
92562
US

V. Phone/Fax

Practice location:
  • Phone: 951-894-5072
  • Fax: 951-894-7324
Mailing address:
  • Phone: 951-894-5072
  • Fax: 951-894-7324

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number33-07
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: