Healthcare Provider Details

I. General information

NPI: 1972843597
Provider Name (Legal Business Name): ELIZABETH ANNE SCOTT RD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: BETH VERSAGE

II. Dates (important events)

Enumeration Date: 02/19/2013
Last Update Date: 02/19/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4650 SUNSET BLVD, MAILSTOP 78
LOS ANGELES CA
90027
US

IV. Provider business mailing address

8121 NAYLOR AVE
WESTCHESTER CA
90045-2914
US

V. Phone/Fax

Practice location:
  • Phone: 323-361-6350
  • Fax:
Mailing address:
  • Phone: 310-365-4626
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133VN1004X
TaxonomyPediatric Nutrition Registered Dietitian
License Number808904
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: