Healthcare Provider Details

I. General information

NPI: 1588574776
Provider Name (Legal Business Name): ERIC DAWES SMITH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/09/2026
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10900 BLUFFSIDE DR APT 118
STUDIO CITY CA
91604-3368
US

IV. Provider business mailing address

10900 BLUFFSIDE DR APT 118
STUDIO CITY CA
91604-3368
US

V. Phone/Fax

Practice location:
  • Phone: 773-263-6047
  • Fax:
Mailing address:
  • Phone: 773-263-6047
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberAE6E9D7193
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: