Healthcare Provider Details

I. General information

NPI: 1982120184
Provider Name (Legal Business Name): SCOTT LAWRENCE VEJAR
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/18/2017
Last Update Date: 08/18/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1245 E WALNUT ST STE 117
PASADENA CA
91106-5129
US

IV. Provider business mailing address

8823 BEAUDINE AVE
SOUTH GATE CA
90280-2603
US

V. Phone/Fax

Practice location:
  • Phone: 626-773-4364
  • Fax:
Mailing address:
  • Phone: 213-393-9197
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: