1750144937 NPI number — DAIJAH MARIE SMITH CD, CPSW, MHFA, CHW

Table of content: DAIJAH MARIE SMITH CD, CPSW, MHFA, CHW (NPI 1750144937)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750144937 NPI number — DAIJAH MARIE SMITH CD, CPSW, MHFA, CHW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SMITH
Provider First Name:
DAIJAH
Provider Middle Name:
MARIE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
CD, CPSW, MHFA, CHW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1750144937
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/12/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9500 OSUNA RD NE APT 1014
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ALBUQUERQUE
Provider Business Mailing Address State Name:
NM
Provider Business Mailing Address Postal Code:
87111-2291
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
505-572-5652
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
300 CENTRAL AVE SW STE 1500E
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ALBUQUERQUE
Provider Business Practice Location Address State Name:
NM
Provider Business Practice Location Address Postal Code:
87102-3293
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
505-369-1731
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/01/2024

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 175T00000X , registered in the state of NM ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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