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NPI Code Detail

MEDICARE: SCOTT ANTHONY MANCUSO M.D.

MEDICARE: SCOTT ANTHONY MANCUSO M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207R00000XInternal Medicine Physician31889AZ

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1962497024
Entity Type Code : Individual
Provider Name (Legal Business Name) : SCOTT ANTHONY MANCUSO M.D.
Provider Business Mailing Address
First Line : 1146 CORONA LN
Second Line :
City : COSTA MESA
State : CA
Zip : 92626-5525
Country : US
Telephone Number : 602-317-7744
Fax Number :
Provider Business Practice Location Address
First Line : 7755 CENTER AVE STE 630
Second Line :
City : HUNTINGTON BEACH
State : CA
Zip : 92647-9152
Country : US
Telephone Number : 657-400-5180
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/14/2005
Last Update Date : 10/28/2019

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