Healthcare Provider Details

I. General information

NPI: 1114003894
Provider Name (Legal Business Name): JOE SCAMAN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/27/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7922 PALM ST
LEMON GROVE CA
91945-2956
US

IV. Provider business mailing address

564 MANOR DR #158
EL CAJON CA
92020-9237
US

V. Phone/Fax

Practice location:
  • Phone: 619-464-3488
  • Fax: 619-464-3416
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code373H00000X
TaxonomyDay Training/Habilitation Specialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: