Provider Demographics
NPI:1013902618
Name:SCOTT, TIMOTHY V (MD)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:V
Last Name:SCOTT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:323 N PRAIRIE AVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:INGLEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90301-4502
Mailing Address - Country:US
Mailing Address - Phone:310-673-5774
Mailing Address - Fax:310-673-9729
Practice Address - Street 1:323 N PRAIRIE AVE
Practice Address - Street 2:
Practice Address - City:INGLEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90301-4502
Practice Address - Country:US
Practice Address - Phone:310-673-5774
Practice Address - Fax:310-673-9729
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-20
Last Update Date:2011-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC34027174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00C340270Medicaid
CA00C340270Medicaid
CAA35476Medicare UPIN