Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0129X | Vascular Surgeon | A94339 | CA |
NPI | 1174617070 |
---|---|
Provider Name | Dr. Scott Edward Musicant |
First Address | La Mesa, CA 91942-3068 |
Second Address | La Mesa, CA 91942-3068 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/10/2006 |
Last Update Date | 20/11/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
I69147 | (02) | CA |