Provider Demographics
NPI:1336235548
Name:SCOTT, LANITA C (MD)
Entity Type:Individual
Prefix:DR
First Name:LANITA
Middle Name:C
Last Name:SCOTT
Suffix:
Gender:F
Credentials:MD
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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
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:SUITE 201
Practice Address - City:INGLEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90301
Practice Address - Country:US
Practice Address - Phone:310-673-5774
Practice Address - Fax:310-673-9729
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAG80783207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G807830Medicaid
CAG80783Medicare ID - Type Unspecified
CA00G807830Medicaid