Provider Demographics
NPI:1861687691
Name:SCOTT, ALICE A
Entity Type:Individual
Prefix:
First Name:ALICE
Middle Name:A
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 1:146 S WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:SONORA
Mailing Address - State:CA
Mailing Address - Zip Code:95370-4712
Mailing Address - Country:US
Mailing Address - Phone:209-532-6149
Mailing Address - Fax:209-532-1822
Practice Address - Street 1:146 S WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:SONORA
Practice Address - State:CA
Practice Address - Zip Code:95370-4712
Practice Address - Country:US
Practice Address - Phone:209-532-6149
Practice Address - Fax:209-532-1822
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-14
Last Update Date:2008-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0939020001Medicare NSC