Provider Demographics
NPI:1982120184
Name:VEJAR, SCOTT LAWRENCE
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:LAWRENCE
Last Name:VEJAR
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8823 BEAUDINE AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH GATE
Mailing Address - State:CA
Mailing Address - Zip Code:90280-2603
Mailing Address - Country:US
Mailing Address - Phone:213-393-9197
Mailing Address - Fax:
Practice Address - Street 1:1245 E WALNUT ST STE 117
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91106-5129
Practice Address - Country:US
Practice Address - Phone:626-773-4364
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-18
Last Update Date:2017-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)