Healthcare Provider Details

I. General information

NPI: 1609396191
Provider Name (Legal Business Name): MONICA E SCOTT RNIII
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MONICA SPARKS M,SCOTT RNIII

II. Dates (important events)

Enumeration Date: 06/26/2017
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1325 BROAD AVE
WILMINGTON CA
90744-2604
US

IV. Provider business mailing address

1325 BROAD AVE
WILMINGTON CA
90744-2604
US

V. Phone/Fax

Practice location:
  • Phone: 310-404-2141
  • Fax: 310-404-2166
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP2201X
TaxonomyAmbulatory Care Registered Nurse
License Number691386
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: