Provider Demographics
NPI:1215570775
Name:SCOTT, ASA KRISTIAN (ATC)
Entity Type:Individual
Prefix:
First Name:ASA
Middle Name:KRISTIAN
Last Name:SCOTT
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2560 LAMBERT DR
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91107-2618
Mailing Address - Country:US
Mailing Address - Phone:626-616-2622
Mailing Address - Fax:
Practice Address - Street 1:2560 LAMBERT DR
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91107-2618
Practice Address - Country:US
Practice Address - Phone:626-616-2622
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-28
Last Update Date:2019-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAJ78467207PS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207PS0010XAllopathic & Osteopathic PhysiciansEmergency MedicineSports Medicine