Healthcare Provider Details

I. General information

NPI: 1184694598
Provider Name (Legal Business Name): SCOTT D FLINN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/26/2006
Last Update Date: 09/14/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15611 POMERADO RD SUITE 400
POWAY CA
92064-2437
US

IV. Provider business mailing address

15945 SHALOM RD
RAMONA CA
92065-4820
US

V. Phone/Fax

Practice location:
  • Phone: 858-673-2574
  • Fax: 858-613-2930
Mailing address:
  • Phone: 760-315-6817
  • Fax: 858-613-2930

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License NumberG68423
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: