Healthcare Provider Details

I. General information

NPI: 1285878017
Provider Name (Legal Business Name): SCOTT L CARDER MD PHD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/23/2009
Last Update Date: 03/16/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

259 S EUCLID AVE
PASADENA CA
91101-2717
US

IV. Provider business mailing address

259 S EUCLID AVE
PASADENA CA
91101-2717
US

V. Phone/Fax

Practice location:
  • Phone: 626-395-7677
  • Fax: 626-395-7834
Mailing address:
  • Phone: 626-395-7677
  • Fax: 626-395-7834

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License NumberC29142
License Number StateCA

VIII. Authorized Official

Name: SCOTT CARDER
Title or Position: PRESIDENT
Credential: M.D., PHD
Phone: 626-395-7677