Provider Demographics
NPI:1790015519
Name:SCOTT, LARRI M (CPT 2)
Entity Type:Individual
Prefix:MRS
First Name:LARRI
Middle Name:M
Last Name:SCOTT
Suffix:
Gender:F
Credentials:CPT 2
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4305 CALSITE CT
Mailing Address - Street 2:
Mailing Address - City:ANTIOCH
Mailing Address - State:CA
Mailing Address - Zip Code:94509-8942
Mailing Address - Country:US
Mailing Address - Phone:925-366-9901
Mailing Address - Fax:925-777-1976
Practice Address - Street 1:4305 CALSITE CT
Practice Address - Street 2:
Practice Address - City:ANTIOCH
Practice Address - State:CA
Practice Address - Zip Code:94509-8942
Practice Address - Country:US
Practice Address - Phone:925-366-9901
Practice Address - Fax:925-777-1976
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-29
Last Update Date:2009-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACPA3793291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory