Healthcare Provider Details

I. General information

NPI: 1790660223
Provider Name (Legal Business Name): MIKAELA SCOTT PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MIKAELA MATTHEWS

II. Dates (important events)

Enumeration Date: 08/06/2025
Last Update Date: 05/29/2026
Certification Date: 05/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5031 FAIR AVE APT 257
NORTH HOLLYWOOD CA
91601-4370
US

IV. Provider business mailing address

5031 FAIR AVE APT 257
NORTH HOLLYWOOD CA
91601-4370
US

V. Phone/Fax

Practice location:
  • Phone: 858-413-5704
  • Fax:
Mailing address:
  • Phone: 858-413-5704
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: