Healthcare Provider Details

I. General information

NPI: 1598575953
Provider Name (Legal Business Name): DILLON M SMITH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/08/2025
Last Update Date: 07/21/2025
Certification Date: 07/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3800 COOLIDGE AVE
OAKLAND CA
94602-3399
US

IV. Provider business mailing address

330 ADAMS ST APT 204
OAKLAND CA
94610-4120
US

V. Phone/Fax

Practice location:
  • Phone: 619-797-1090
  • Fax:
Mailing address:
  • Phone: 224-456-9098
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number19898
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: