Healthcare Provider Details

I. General information

NPI: 1891287793
Provider Name (Legal Business Name): COURTNEY S. SCOTT, MD INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/06/2018
Last Update Date: 06/06/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

233 N PRAIRIE AVE
INGLEWOOD CA
90301-1412
US

IV. Provider business mailing address

4530 VARNA AVE
SHERMAN OAKS CA
91423-3128
US

V. Phone/Fax

Practice location:
  • Phone: 310-622-3300
  • Fax:
Mailing address:
  • Phone: 310-622-3300
  • Fax: 818-855-2375

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084A0401X
TaxonomyAddiction Medicine (Psychiatry & Neurology) Physician
License NumberA108390
License Number StateCA

VIII. Authorized Official

Name: DR. COURTNEY S SCOTT
Title or Position: CEO
Credential: MD
Phone: 310-622-3300