Healthcare Provider Details

I. General information

NPI: 1356181101
Provider Name (Legal Business Name): MAURESHA DENAYE' SMITH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/29/2024
Last Update Date: 06/04/2025
Certification Date: 06/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6950 65TH ST
SACRAMENTO CA
95823-2316
US

IV. Provider business mailing address

6950 65TH ST
SACRAMENTO CA
95823-2316
US

V. Phone/Fax

Practice location:
  • Phone: 916-220-5228
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: