MEDICARE: JAVIONA SMITH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106S00000X	Behavior Technician	RBT24389030

General Provider Information

NPI Number	:	1306709183
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAVIONA SMITH

Provider Business Mailing Address
First Line	:	3623 OLYMPUS MONS
Second Line	:
City	:	CONVERSE
State	:	TX
Zip	:	78109-3811
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	11503 JONES MALTSBERGER RD STE 1104
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78216-2630
Country	:	US
Telephone Number	:	210-264-7053
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/08/2025
Last Update Date	:	12/08/2025

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Directions to “ JAVIONA SMITH ” Practice Location

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