Healthcare Provider Details

I. General information

NPI: 1447306014
Provider Name (Legal Business Name): EARNEST SCOTT L.P.T.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/26/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27822 EL LAZO
LAGUNA NIGUEL CA
92677-3915
US

IV. Provider business mailing address

800 S SANTA ANITA AVE
ARCADIA CA
91006-6853
US

V. Phone/Fax

Practice location:
  • Phone: 949-360-5810
  • Fax:
Mailing address:
  • Phone: 949-360-5810
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code167G00000X
TaxonomyLicensed Psychiatric Technician
License NumberPT 29226
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: