Provider Demographics
NPI:1063535672
Name:SMITH, AARON (PSYD)
Entity type:Individual
Prefix:DR
First Name:AARON
Middle Name:
Last Name:SMITH
Suffix:
Gender:M
Credentials:PSYD
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:ST 309
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92883-4625
Mailing Address - Country:US
Mailing Address - Phone:951-317-4499
Mailing Address - Fax:
Practice Address - Street 1:4160 TEMESCAL CANYON RD
Practice Address - Street 2:ST 309
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92883-4625
Practice Address - Country:US
Practice Address - Phone:951-317-4499
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-09
Last Update Date:2016-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 27941103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical