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General NPI Number Information
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NPI Number | 1306719497
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Entity Type | Individual
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Provider Name | MR. EDWARD LEON SMITH JR.
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Gender | Male
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Dates
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Enumeration Date | 09/25/2025
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Last Update Date | 09/29/2025
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Provider Practice Location Address
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Address Line | 1803 W MARCH LN
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City | STOCKTON
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State | CA
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Zip | 95207-6458
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Country | US
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Telephone | 209-636-5353
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Fax |
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Provider Business Mailing Address
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Address Line | 1827 BELLA LAGO DR
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City | STOCKTON
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State | CA
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Zip | 95206-1124
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Country | US
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Telephone | 510-331-5664
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 373H00000X
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Taxonomy Name | Day Training/Habilitation Specialist
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License Number |
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License Number State | CA
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