Healthcare Provider Details

I. General information

NPI: 1225966658
Provider Name (Legal Business Name): SCOTT BROWN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/13/2026
Last Update Date: 05/13/2026
Certification Date: 05/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

91 MERCEDES LN
OAKLEY CA
94561-4617
US

IV. Provider business mailing address

91 MERCEDES LN
OAKLEY CA
94561-4617
US

V. Phone/Fax

Practice location:
  • Phone: 415-625-0700
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number250088038
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: