Healthcare Provider Details

I. General information

NPI: 1497894166
Provider Name (Legal Business Name): STEPHANIE A. SCOTT MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/06/2007
Last Update Date: 01/14/2022
Certification Date: 01/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

275 W MACARTHUR
OAKLAND CA
94611-5641
US

IV. Provider business mailing address

275 W MACARTHUR
OAKLAND CA
94611-5641
US

V. Phone/Fax

Practice location:
  • Phone: 510-752-1000
  • Fax: 415-876-4538
Mailing address:
  • Phone: 510-752-1000
  • Fax: 415-876-4538

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA62386
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: