Healthcare Provider Details

I. General information

NPI: 1902170954
Provider Name (Legal Business Name): RACHEL ELIZABETH HANIS SCOTT PA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/07/2012
Last Update Date: 06/12/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

475 BRUCE ST STE 700
YREKA CA
96097-3473
US

IV. Provider business mailing address

475 BRUCE ST STE 700
YREKA CA
96097-3473
US

V. Phone/Fax

Practice location:
  • Phone: 530-842-9800
  • Fax: 530-842-9054
Mailing address:
  • Phone: 530-842-9800
  • Fax: 530-842-9054

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number22132
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: