Healthcare Provider Details

I. General information

NPI: 1457838765
Provider Name (Legal Business Name): HARRISON LORNE SCOTT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2018
Last Update Date: 07/19/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45280 SEELEY DR
LA QUINTA CA
92253-6834
US

IV. Provider business mailing address

22714 COLLINS ST
WOODLAND HILLS CA
91367-4434
US

V. Phone/Fax

Practice location:
  • Phone: 760-610-7210
  • Fax:
Mailing address:
  • Phone: 818-312-7363
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number293568
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: