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General NPI Number Information
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NPI Number | 1205918588
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Entity Type | Individual
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Provider Name | WARREN SCOTT LINE JR. MD
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Gender | Male
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Dates
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Enumeration Date | 10/19/2006
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Last Update Date | 03/18/2014
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Provider Practice Location Address
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Address Line | 191 S BUENA VISTA ST SUITE #320
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City | BURBANK
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State | CA
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Zip | 91505-4554
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Country | US
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Telephone | 818-559-9727
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Fax | 818-559-5514
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Provider Business Mailing Address
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Address Line | 191 S BUENA VISTA ST SUITE #320
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City | BURBANK
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State | CA
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Zip | 91505-4554
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Country | US
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Telephone | 818-559-9727
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Fax | 818-559-5514
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207YX0007X
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Taxonomy Name | Plastic Surgery within the Head & Neck (Otolaryngology) Physician
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License Number | G48150
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License Number State | CA
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