Healthcare Provider Details

I. General information

NPI: 1750736005
Provider Name (Legal Business Name): DAMAILI KAMILI SMOTHERS RADT-1
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/24/2016
Last Update Date: 06/10/2026
Certification Date: 06/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7240 E SOUTHGATE DR STE G
SACRAMENTO CA
95823-2627
US

IV. Provider business mailing address

9355 E STOCKTON BLVD STE 100
ELK GROVE CA
95624-9476
US

V. Phone/Fax

Practice location:
  • Phone: 916-391-4293
  • Fax: 916-391-4247
Mailing address:
  • Phone: 916-714-5400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License NumberMPSS-ZLWFON
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code372600000X
TaxonomyAdult Companion
License NumberB4042003
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: