Provider Demographics
NPI:1881707545
Name:ZITTEL, SCOTT R (DO)
Entity type:Individual
Prefix:
First Name:SCOTT
Middle Name:R
Last Name:ZITTEL
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 994307
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96099-4307
Mailing Address - Country:US
Mailing Address - Phone:530-241-2151
Mailing Address - Fax:530-241-2489
Practice Address - Street 1:2770 EUREKA WAY
Practice Address - Street 2:SUITE 100
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96001-0252
Practice Address - Country:US
Practice Address - Phone:530-241-2151
Practice Address - Fax:530-241-2489
Is Sole Proprietor?:No
Enumeration Date:2006-08-16
Last Update Date:2014-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A7449207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00AX74490Medicaid
CA020A74494Medicare PIN
CAG99896Medicare UPIN
CA020A74492Medicare PIN
CA020A74493Medicare PIN
CA00AX74490Medicaid