Healthcare Provider Details

I. General information

NPI: 1891669867
Provider Name (Legal Business Name): BRETT A SMITH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2025
Last Update Date: 04/14/2026
Certification Date: 04/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1865 HOTEL CIR S
SAN DIEGO CA
92108-3319
US

IV. Provider business mailing address

1865 HOTEL CIR S
SAN DIEGO CA
92108-3319
US

V. Phone/Fax

Practice location:
  • Phone: 619-673-8116
  • Fax: 619-573-9333
Mailing address:
  • Phone: 619-673-8116
  • Fax: 619-573-9333

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number13848
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: