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General NPI Number Information
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NPI Number | 1235780289
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Entity Type | Individual
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Provider Name | MADISON SCOUT STARGELL PA-C
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Gender | Female
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Dates
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Enumeration Date | 09/20/2019
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Last Update Date | 09/20/2019
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Provider Practice Location Address
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Address Line | 38780 TRADE CENTER DR # 1C
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City | PALMDALE
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State | CA
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Zip | 93551-3641
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Country | US
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Telephone | 661-947-5600
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Fax |
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Provider Business Mailing Address
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Address Line | 24565 TOWN CENTER DR APT 8209
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City | VALENCIA
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State | CA
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Zip | 91355-0818
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Country | US
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Telephone | 903-918-7065
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Fax |
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 57239
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License Number State | CA
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