Provider Demographics
NPI:1144963323
Name:SMIDI, HODA SR (P)
Entity type:Individual
Prefix:MRS
First Name:HODA
Middle Name:
Last Name:SMIDI
Suffix:SR
Gender:F
Credentials:P
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:399 TAYLOR BLVD
Mailing Address - Street 2:
Mailing Address - City:PLEASANT HILL
Mailing Address - State:CA
Mailing Address - Zip Code:94523-2297
Mailing Address - Country:US
Mailing Address - Phone:415-233-3371
Mailing Address - Fax:
Practice Address - Street 1:399 TAYLOR BLVD
Practice Address - Street 2:
Practice Address - City:PLEASANT HILL
Practice Address - State:CA
Practice Address - Zip Code:94523-2297
Practice Address - Country:US
Practice Address - Phone:925-944-2244
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-15
Last Update Date:2022-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY20457103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical