Healthcare Provider Details

I. General information

NPI: 1104760933
Provider Name (Legal Business Name): MICHAEL SMART
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/14/2026
Last Update Date: 04/14/2026
Certification Date: 04/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 W KIMBERLY AVE STE 220
PLACENTIA CA
92870-6314
US

IV. Provider business mailing address

635 N CHIPPEWA AVE APT 87
ANAHEIM CA
92801-4439
US

V. Phone/Fax

Practice location:
  • Phone: 714-879-4274
  • Fax:
Mailing address:
  • Phone: 562-746-7353
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: