MEDICARE: DAWN LEE 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

General Provider Information

NPI Number	:	1477112753
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAWN LEE SMITH

Provider Business Mailing Address
First Line	:	8362 FONTAINBLEAU WAY
Second Line	:
City	:	CYPRESS
State	:	CA
Zip	:	90630-2033
Country	:	US
Telephone Number	:	714-269-5389
Fax Number	:

Provider Business Practice Location Address
First Line	:	12062 VALLEY VIEW ST STE 103
Second Line	:
City	:	GARDEN GROVE
State	:	CA
Zip	:	92845-1738
Country	:	US
Telephone Number	:	657-444-9002
Fax Number	:

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

Provider Enumeration Date	:	06/10/2019
Last Update Date	:	06/10/2019

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