Provider Demographics
NPI:1801386545
Name:SCOTT, SAMANTHA RENE
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:RENE
Last Name:SCOTT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23259 JOAQUIN RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:MURRIETA
Mailing Address - State:CA
Mailing Address - Zip Code:92562-3208
Mailing Address - Country:US
Mailing Address - Phone:951-290-1175
Mailing Address - Fax:
Practice Address - Street 1:23259 JOAQUIN RIDGE DR
Practice Address - Street 2:
Practice Address - City:MURRIETA
Practice Address - State:CA
Practice Address - Zip Code:92562-3208
Practice Address - Country:US
Practice Address - Phone:951-290-1175
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-17
Last Update Date:2018-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician