Provider Demographics
NPI:1740070077
Name:MCFADDEN, SCOTT J
Entity type:Individual
Prefix:
First Name:SCOTT
Middle Name:J
Last Name:MCFADDEN
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45800 BOULDER WAY
Mailing Address - Street 2:
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92592-4228
Mailing Address - Country:US
Mailing Address - Phone:951-595-9193
Mailing Address - Fax:
Practice Address - Street 1:45800 BOULDER WAY
Practice Address - Street 2:
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92592-4228
Practice Address - Country:US
Practice Address - Phone:951-595-9193
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-09
Last Update Date:2025-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD2015013525363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner