Healthcare Provider Details

I. General information

NPI: 1437735958
Provider Name (Legal Business Name): CARLA KOMON DE SOUZA SCOTT MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2021
Last Update Date: 03/23/2021
Certification Date: 03/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5323 HARRY HINES BLVD # MC9157
DALLAS TX
75390-9157
US

IV. Provider business mailing address

5323 HARRY HINES BLVD # MC9157
DALLAS TX
75390-9157
US

V. Phone/Fax

Practice location:
  • Phone: 214-645-0545
  • Fax: 214-645-0546
Mailing address:
  • Phone: 214-645-0545
  • Fax: 214-645-0546

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 State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: