Individual
ACACIA SMITH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
45278 DEEP CANYON RD APT 104A, PALM DESERT, CA 92260-4516
(626) 203-3416
Mailing address
45278 DEEP CANYON RD APT 104A, PALM DESERT, CA 92260-4516
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0000206612279
KAISER
—
Enumeration date
08/23/2018
Last updated
08/23/2018
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