Healthcare Provider Details

I. General information

NPI: 1508961202
Provider Name (Legal Business Name): KATHLEEN ELIZABETH SCOTT NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2006
Last Update Date: 09/12/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2400 MOORPARK AVE OCCUPATIONAL MED CLINIC
SAN JOSE CA
95128-2631
US

IV. Provider business mailing address

751 S BASCOM AVE
SAN JOSE CA
95128-2604
US

V. Phone/Fax

Practice location:
  • Phone: 408-885-2031
  • Fax:
Mailing address:
  • Phone: 408-885-5000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LX0106X
TaxonomyOccupational Health Nurse Practitioner
License NumberRN251655
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: