Healthcare Provider Details

I. General information

NPI: 1518522903
Provider Name (Legal Business Name): CAMILLE M SCOTT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/01/2019
Last Update Date: 11/22/2023
Certification Date: 11/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3925 FAIRMONT PKWY
PASADENA TX
77504-3013
US

IV. Provider business mailing address

6621 FANNIN ST # W1985
HOUSTON TX
77030-2358
US

V. Phone/Fax

Practice location:
  • Phone: 713-873-6300
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberU2635
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: