1962643916 NPI number — MISS ROSE SCOTT LVN

Table of content: MISS ROSE SCOTT LVN (NPI 1962643916)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1962643916 NPI number — MISS ROSE SCOTT LVN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SCOTT
Provider First Name:
ROSE
Provider Middle Name:
Provider Name Prefix Text:
MISS
Provider Name Suffix Text:
Provider Credential Text:
LVN
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:
1962643916
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/11/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
589 AMERICANA WAY
Provider Second Line Business Mailing Address:
#205
Provider Business Mailing Address City Name:
GLENDALE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91210-1523
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
323-608-9895
Provider Business Mailing Address Fax Number:
323-982-8516

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
589 AMERICANA WAY
Provider Second Line Business Practice Location Address:
#205
Provider Business Practice Location Address City Name:
GLENDALE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91210-1523
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-608-9895
Provider Business Practice Location Address Fax Number:
323-982-8516
Provider Enumeration Date:
03/19/2009

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: 164X00000X , with the licence number:  VN 170020 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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