Healthcare Provider Details

I. General information

NPI: 1407585029
Provider Name (Legal Business Name): SCOTT CHIV
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2022
Last Update Date: 06/08/2022
Certification Date: 05/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16959 BERNARDO CENTER DR STE 210
SAN DIEGO CA
92128-2555
US

IV. Provider business mailing address

16959 BERNARDO CENTER DR STE 210
SAN DIEGO CA
92128-2555
US

V. Phone/Fax

Practice location:
  • Phone: 858-888-9632
  • Fax:
Mailing address:
  • Phone: 858-888-9632
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number0E16930
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: