Provider Demographics
NPI:1841186053
Name:SMITH, MIKENSI JUNKO I
Entity type:Individual
Prefix:MISS
First Name:MIKENSI
Middle Name:JUNKO
Last Name:SMITH
Suffix:I
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:MIKI
Other - Middle Name:JUNKI
Other - Last Name:SMITH
Other - Suffix:I
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:33721 MCKENNY PL
Mailing Address - Street 2:
Mailing Address - City:YUCAIPA
Mailing Address - State:CA
Mailing Address - Zip Code:92399-6955
Mailing Address - Country:US
Mailing Address - Phone:909-297-4810
Mailing Address - Fax:
Practice Address - Street 1:11799 SEBASTIAN WAY STE 103
Practice Address - Street 2:
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730-0708
Practice Address - Country:US
Practice Address - Phone:909-353-7547
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-16
Last Update Date:2025-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician