Healthcare Provider Details

I. General information

NPI: 1134043672
Provider Name (Legal Business Name): DAVID SCOTT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/06/2026
Last Update Date: 08/06/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1480 LINCOLN AVE
SAN RAFAEL CA
94901-2084
US

IV. Provider business mailing address

PO BOX 266
SEBASTOPOL CA
95473-0266
US

V. Phone/Fax

Practice location:
  • Phone: 415-456-1050
  • Fax:
Mailing address:
  • Phone: 707-318-3144
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: