Provider Demographics
NPI:1598465502
Name:SCOTT, BRANDON BERTRILLE
Entity Type:Individual
Prefix:
First Name:BRANDON
Middle Name:BERTRILLE
Last Name:SCOTT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4119 PRESIDENTS DR S
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77047-6763
Mailing Address - Country:US
Mailing Address - Phone:832-865-9559
Mailing Address - Fax:832-740-4045
Practice Address - Street 1:4119 PRESIDENTS DR S.
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77047
Practice Address - Country:US
Practice Address - Phone:832-865-9559
Practice Address - Fax:832-740-4045
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-08
Last Update Date:2023-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX15133413347C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347C00000XTransportation ServicesPrivate Vehicle