Healthcare Provider Details

I. General information

NPI: 1487160990
Provider Name (Legal Business Name): WHITNEY SMITH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/19/2017
Last Update Date: 07/16/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28877 PUJOL ST
TEMECULA CA
92590-6733
US

IV. Provider business mailing address

8787 COMPLEX DR STE 300
SAN DIEGO CA
92123-1453
US

V. Phone/Fax

Practice location:
  • Phone: 951-566-6263
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-21-54130
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number17-35164
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: