Provider Demographics
NPI:1528208287
Name:SCORD, KRISTIN E (PA)
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:E
Last Name:SCORD
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3900 W COAST HWY
Mailing Address - Street 2:SUITE 300
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92663-4091
Mailing Address - Country:US
Mailing Address - Phone:949-642-6787
Mailing Address - Fax:949-642-4833
Practice Address - Street 1:3900 W COAST HWY
Practice Address - Street 2:SUITE 300
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92663-4091
Practice Address - Country:US
Practice Address - Phone:949-642-6787
Practice Address - Fax:949-642-4833
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-20
Last Update Date:2017-07-25
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAPA20048363AS0400X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical