Provider Demographics
NPI:1518176767
Name:SMITH, JAZIAH M
Entity Type:Individual
Prefix:
First Name:JAZIAH
Middle Name:M
Last Name:SMITH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:58923 BUSINESS CENTERED DR
Mailing Address - Street 2:
Mailing Address - City:YUCCA VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92284
Mailing Address - Country:US
Mailing Address - Phone:760-365-7209
Mailing Address - Fax:760-228-2887
Practice Address - Street 1:58923 BUSINESS CENTERED DR
Practice Address - Street 2:
Practice Address - City:YUCCA VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92284-3117
Practice Address - Country:US
Practice Address - Phone:603-657-2097
Practice Address - Fax:603-657-2097
Is Sole Proprietor?:No
Enumeration Date:2007-05-22
Last Update Date:2019-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator