Provider Demographics
NPI:1801653209
Name:SMITH, MAKAYLA NIKKOLE I (NONE)
Entity type:Individual
Prefix:MS
First Name:MAKAYLA
Middle Name:NIKKOLE
Last Name:SMITH
Suffix:I
Gender:F
Credentials:NONE
Other - Prefix:MS
Other - First Name:MAKAYLA
Other - Middle Name:NIKKOLE
Other - Last Name:SMITH
Other - Suffix:I
Other - Last Name Type:Other Name
Other - Credentials:NONE
Mailing Address - Street 1:3878 RUFFIN RD STE B
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92123-1842
Mailing Address - Country:US
Mailing Address - Phone:619-739-4569
Mailing Address - Fax:
Practice Address - Street 1:3878 RUFFIN RD STE B
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123-1842
Practice Address - Country:US
Practice Address - Phone:619-739-4569
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-01
Last Update Date:2024-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician