Provider Demographics
NPI:1528417185
Name:BROWN, SCOTT (CMT)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:
Last Name:BROWN
Suffix:
Gender:M
Credentials:CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7590 FAY AVE
Mailing Address - Street 2:SUITE 520
Mailing Address - City:LA JOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92037-4885
Mailing Address - Country:US
Mailing Address - Phone:858-876-8221
Mailing Address - Fax:
Practice Address - Street 1:7590 FAY AVE
Practice Address - Street 2:SUITE 520
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92037-4885
Practice Address - Country:US
Practice Address - Phone:858-876-8221
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-05
Last Update Date:2016-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA2134225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist