Healthcare Provider Details

I. General information

NPI: 1306708029
Provider Name (Legal Business Name): ANDREW DANIEL SCOGGINS CAADE#25391
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/01/2025
Last Update Date: 12/01/2025
Certification Date: 12/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3424 COGSWELL RD APT 10
EL MONTE CA
91732-2730
US

IV. Provider business mailing address

3424 COGSWELL RD APT 10
EL MONTE CA
91732-2730
US

V. Phone/Fax

Practice location:
  • Phone: 323-345-7013
  • Fax:
Mailing address:
  • Phone: 323-345-7013
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number25391
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: