Provider Demographics
NPI:1114323201
Name:TERCERO, SCOTT ELIOT (MHS, PA-C)
Entity Type:Individual
Prefix:MR
First Name:SCOTT
Middle Name:ELIOT
Last Name:TERCERO
Suffix:
Gender:M
Credentials:MHS, PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1 EMBARCADERO CTR STE 1900
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94111-3723
Mailing Address - Country:US
Mailing Address - Phone:415-658-6791
Mailing Address - Fax:
Practice Address - Street 1:110 SUTTER ST
Practice Address - Street 2:6TH FLOOR
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94104-4002
Practice Address - Country:US
Practice Address - Phone:415-291-0480
Practice Address - Fax:415-291-0489
Is Sole Proprietor?:No
Enumeration Date:2014-11-17
Last Update Date:2020-06-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA52078363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant