Individual
MR. KEVIN ETWOOD SMITH JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
929 N VAL VISTA DR STE 109, GILBERT, AZ 85234-3701
(480) 862-3648
Mailing address
1405 N ST PAUL, MESA, AZ 85205-6864
(480) 862-3648
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
—
AZ
261QA0600X
Adult Day Care Clinic/Center
—
AZ
261QD1600X
Developmental Disabilities Clinic/Center
Primary
—
AZ
310400000X
Assisted Living Facility
—
AZ
Other
Enumeration date
06/21/2024
Last updated
08/05/2025
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