Healthcare Provider Details

I. General information

NPI: 1114064706
Provider Name (Legal Business Name): PATRICIA DENISE SMITH CNA, CHHA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/31/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 IOWA AVE SUITE 230
RIVERSIDE CA
92507-2420
US

IV. Provider business mailing address

1355 S PERRIS BLVD #168
PERRIS CA
92570-2584
US

V. Phone/Fax

Practice location:
  • Phone: 951-369-8604
  • Fax: 951-715-4594
Mailing address:
  • Phone: 951-443-1088
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number00130600
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number00433753
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: