Healthcare Provider Details

I. General information

NPI: 1437647120
Provider Name (Legal Business Name): MISHA RAYNE SCOTT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/27/2018
Last Update Date: 08/21/2025
Certification Date: 08/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6060 SUNRISE VISTA DR STE 2100
CITRUS HEIGHTS CA
95610-7068
US

IV. Provider business mailing address

6060 SUNRISE VISTA DR STE 2100
CITRUS HEIGHTS CA
95610-7068
US

V. Phone/Fax

Practice location:
  • Phone: 916-967-6253
  • Fax:
Mailing address:
  • Phone: 916-967-6253
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: