Healthcare Provider Details

I. General information

NPI: 1912862319
Provider Name (Legal Business Name): ALLIYAH MONIQUE SMITH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/17/2025
Last Update Date: 07/01/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

81 W MARCH LN
STOCKTON CA
95207-5723
US

IV. Provider business mailing address

1510 CAT TAIL DR
STOCKTON CA
95204-1765
US

V. Phone/Fax

Practice location:
  • Phone: 877-828-8476
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: