Healthcare Provider Details

I. General information

NPI: 1578254736
Provider Name (Legal Business Name): DANIEL ERIC SMITH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2023
Last Update Date: 07/08/2026
Certification Date: 07/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8585 SW CASCADE AVE STE 200
BEAVERTON OR
97008-7496
US

IV. Provider business mailing address

DEPT LA 22763
PASADENA CA
91185-0001
US

V. Phone/Fax

Practice location:
  • Phone: 866-523-4268
  • Fax: 510-900-4310
Mailing address:
  • Phone: 665-234-2688
  • Fax: 510-900-4310

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-26-90601
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: