Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0200X | Nurse Practitioner - Pediatrics | NP10261 | CA |
NPI | 1023223252 |
---|---|
Provider Name | Marylou Scott |
First Address | San Diego, CA 92123-4802 |
Second Address | San Diego, CA 92123-4232 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/05/2007 |
Last Update Date | 25/10/2012 |