Provider Demographics
NPI:1336566348
Name:VELTRE, SCOTT (MSN, PMHNP)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:
Last Name:VELTRE
Suffix:
Gender:M
Credentials:MSN, PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5887 BROCKTON AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92506-1853
Mailing Address - Country:US
Mailing Address - Phone:951-275-8500
Mailing Address - Fax:951-275-8560
Practice Address - Street 1:5887 BROCKTON AVE
Practice Address - Street 2:SUITE A
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92506-1853
Practice Address - Country:US
Practice Address - Phone:951-275-8500
Practice Address - Fax:951-275-8560
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-27
Last Update Date:2014-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95000353364SP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0809XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Adult