Healthcare Provider Details

I. General information

NPI: 1952878795
Provider Name (Legal Business Name): SCCT MEDICAL GROUP, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/30/2018
Last Update Date: 04/18/2024
Certification Date: 04/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23845 MCBEAN PKWY
VALENCIA CA
91355-2001
US

IV. Provider business mailing address

23845 MCBEAN PKWY
VALENCIA CA
91355-2001
US

V. Phone/Fax

Practice location:
  • Phone: 661-200-1122
  • Fax: 661-200-1119
Mailing address:
  • Phone: 661-200-1122
  • Fax: 661-200-1119

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: KELLY WALSMA
Title or Position: OWNER
Credential: MD
Phone: 314-620-8573