Provider Demographics
NPI:1720777568
Name:SCOTT, GABRIELLE NICOLE (MPH, RD)
Entity Type:Individual
Prefix:MS
First Name:GABRIELLE
Middle Name:NICOLE
Last Name:SCOTT
Suffix:
Gender:F
Credentials:MPH, RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4807 N SUNFLOWER AVE APT C
Mailing Address - Street 2:
Mailing Address - City:COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91724-1843
Mailing Address - Country:US
Mailing Address - Phone:626-716-7177
Mailing Address - Fax:
Practice Address - Street 1:428 HARRISON AVE # 101
Practice Address - Street 2:
Practice Address - City:CLAREMONT
Practice Address - State:CA
Practice Address - Zip Code:91711-4605
Practice Address - Country:US
Practice Address - Phone:626-716-7177
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-08
Last Update Date:2023-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA86211248133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered