Provider Demographics
NPI:1538917216
Name:SMITH-MAYERS, JUSTIN QUARON
Entity type:Individual
Prefix:MR
First Name:JUSTIN
Middle Name:QUARON
Last Name:SMITH-MAYERS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2751 W RIVER DR APT 223
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95833-3779
Mailing Address - Country:US
Mailing Address - Phone:916-892-7818
Mailing Address - Fax:
Practice Address - Street 1:2751 W RIVER DR APT 223
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95833-3779
Practice Address - Country:US
Practice Address - Phone:916-212-8280
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-08
Last Update Date:2024-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE1506409343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)