Provider Demographics
NPI:1427193457
Name:SCOTT, LYNE GOODLETT (MD)
Entity Type:Individual
Prefix:
First Name:LYNE
Middle Name:GOODLETT
Last Name:SCOTT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:7251 KATHERINE AVE
Mailing Address - Street 2:
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91405-2434
Mailing Address - Country:US
Mailing Address - Phone:323-226-3813
Mailing Address - Fax:323-226-5049
Practice Address - Street 1:1801 MARENGO ST RM 1G1
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90033-1365
Practice Address - Country:US
Practice Address - Phone:323-226-3813
Practice Address - Fax:323-226-5049
Is Sole Proprietor?:No
Enumeration Date:2007-02-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA915892080P0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0201XAllopathic & Osteopathic PhysiciansPediatricsPediatric Allergy/Immunology