Provider Demographics
NPI:1508071036
Name:SMITH, DAVID STAFFORD (PHD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:STAFFORD
Last Name:SMITH
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4160 TEMESCAL CANYON RD
Mailing Address - Street 2:SUITE 309
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92883-4625
Mailing Address - Country:US
Mailing Address - Phone:714-324-2209
Mailing Address - Fax:
Practice Address - Street 1:4160 TEMESCAL CANYON RD
Practice Address - Street 2:SUITE 309
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92883-4625
Practice Address - Country:US
Practice Address - Phone:714-307-1784
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-10
Last Update Date:2016-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY10774103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical