1366704777 NPI number — SCOTT E DLUGOS MD

Table of content: MIKKA GRACE MARSHALL COTA/L (NPI 1770151805)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1366704777 NPI number — SCOTT E DLUGOS MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SCOTT E DLUGOS MD
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1366704777
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/28/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3251 CELINDA DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CARLSBAD
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92008-2070
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
858-212-9055
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1415 ROSS AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EL CENTRO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92243
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-339-4983
Provider Business Practice Location Address Fax Number:
760-339-4948
Provider Enumeration Date:
06/12/2012

Additional Information

Authorized Official

Authorized Official Last Name:
DLUGOS
Authorized Official First Name:
SCOTT
Authorized Official Middle Name:
E
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
858-212-9055

Provider Taxonomy Codes

  • Taxonomy code: 207PE0004X , with the licence number:  G77449 , 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)





Copyright © 2007-2025 www.npivalidator.com