Provider Demographics
NPI:1114109626
Name:SCOTT, DANA NICOLE (MD)
Entity Type:Individual
Prefix:DR
First Name:DANA
Middle Name:NICOLE
Last Name:SCOTT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:4859 W. SLAUSON AVE
Mailing Address - Street 2:#305
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90056
Mailing Address - Country:US
Mailing Address - Phone:213-375-4944
Mailing Address - Fax:888-534-5766
Practice Address - Street 1:617 W. MANCHESTER BLVD.
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90044
Practice Address - Country:US
Practice Address - Phone:213-375-4944
Practice Address - Fax:888-534-5766
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-27
Last Update Date:2012-04-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA100321208600000X, 208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
No208600000XAllopathic & Osteopathic PhysiciansSurgery