Healthcare Provider Details

I. General information

NPI: 1063860435
Provider Name (Legal Business Name): LA DAWNA SMOOTH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/26/2016
Last Update Date: 08/18/2021
Certification Date: 08/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7171 BOWLING DR STE 300
SACRAMENTO CA
95823-2043
US

IV. Provider business mailing address

7000 FRANKLIN BLVD STE 200
SACRAMENTO CA
95823-1865
US

V. Phone/Fax

Practice location:
  • Phone: 916-394-9195
  • Fax:
Mailing address:
  • Phone: 916-394-9195
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: