Healthcare Provider Details

I. General information

NPI: 1043916133
Provider Name (Legal Business Name): JOHN SCOTT LIVINGSTONE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/01/2023
Last Update Date: 02/01/2023
Certification Date: 09/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22675 HILLS RANCH RD
NUEVO CA
92567
US

IV. Provider business mailing address

21402 LITTLE VALLEY RD
PERRIS CA
92570-9819
US

V. Phone/Fax

Practice location:
  • Phone: 714-271-2455
  • Fax:
Mailing address:
  • Phone: 714-271-2455
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225C00000X
TaxonomyRehabilitation Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: