Provider Demographics
NPI:1073193405
Name:VAN VORIS, SCOTT ERIC
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:ERIC
Last Name:VAN VORIS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1526 PALOS VERDE CT
Mailing Address - Street 2:
Mailing Address - City:EL DORADO HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:95762-4084
Mailing Address - Country:US
Mailing Address - Phone:916-995-9876
Mailing Address - Fax:
Practice Address - Street 1:895 EMBARCADERO DR
Practice Address - Street 2:
Practice Address - City:EL DORADO HILLS
Practice Address - State:CA
Practice Address - Zip Code:95762-4096
Practice Address - Country:US
Practice Address - Phone:916-538-1683
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-09
Last Update Date:2021-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date: