Provider Demographics
NPI:1033930201
Name:SCOTT, JIONNI SEBASTIAN
Entity type:Individual
Prefix:
First Name:JIONNI
Middle Name:SEBASTIAN
Last Name:SCOTT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:451 E VANDERBILT WAY STE 325
Mailing Address - Street 2:
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92408-2881
Mailing Address - Country:US
Mailing Address - Phone:909-501-1074
Mailing Address - Fax:
Practice Address - Street 1:451 E VANDERBILT WAY STE 325
Practice Address - Street 2:
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92408-2881
Practice Address - Country:US
Practice Address - Phone:909-501-1074
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-21
Last Update Date:2024-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker