Provider Demographics
NPI:1205918588
Name:LINE, WARREN SCOTT JR (MD)
Entity type:Individual
Prefix:
First Name:WARREN
Middle Name:SCOTT
Last Name:LINE
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:191 S BUENA VISTA ST
Mailing Address - Street 2:SUITE #320
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91505-4554
Mailing Address - Country:US
Mailing Address - Phone:818-559-9727
Mailing Address - Fax:818-559-5514
Practice Address - Street 1:191 S BUENA VISTA ST
Practice Address - Street 2:SUITE #320
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91505-4554
Practice Address - Country:US
Practice Address - Phone:818-559-9727
Practice Address - Fax:818-559-5514
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2014-03-18
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAG48150207YX0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YX0007XAllopathic & Osteopathic PhysiciansOtolaryngologyPlastic Surgery within the Head & Neck
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA6177618Medicaid
CA6177618Medicaid
CAG48150Medicare ID - Type Unspecified