Healthcare Provider Details

I. General information

NPI: 1225841307
Provider Name (Legal Business Name): SCOTT ANTHONY WASHBURN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/31/2025
Last Update Date: 01/31/2025
Certification Date: 01/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11500 PARAMOUNT BLVD
DOWNEY CA
90241-4530
US

IV. Provider business mailing address

11101 IMPERIAL HWY SPC 39
NORWALK CA
90650-1541
US

V. Phone/Fax

Practice location:
  • Phone: 562-923-4545
  • Fax:
Mailing address:
  • Phone: 562-379-1556
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: