Provider Demographics
NPI:1013356690
Name:SCOTT, PAMELA ROSE (LAC, CMT)
Entity Type:Individual
Prefix:MS
First Name:PAMELA
Middle Name:ROSE
Last Name:SCOTT
Suffix:
Gender:F
Credentials:LAC, CMT
Other - Prefix:
Other - First Name:PAMELA
Other - Middle Name:
Other - Last Name:PRESCOTT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:1321 N. FAIRFAX AVE.
Mailing Address - Street 2:#3
Mailing Address - City:WEST HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90046
Mailing Address - Country:US
Mailing Address - Phone:323-969-0706
Mailing Address - Fax:
Practice Address - Street 1:1321 N. FAIRFAX AVE.
Practice Address - Street 2:#3
Practice Address - City:WEST HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:90046
Practice Address - Country:US
Practice Address - Phone:323-969-0706
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-18
Last Update Date:2013-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC15327171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist