=====================================================
General NPI Number Information
=====================================================
NPI Number | 1306289566
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ANJAIL SCOTT
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/08/2013
-----------------------------------------------------
Last Update Date | 04/08/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1054 LEESBURG ST
-----------------------------------------------------
City | LAS VEGAS
-----------------------------------------------------
State | NV
-----------------------------------------------------
Zip | 89110-2578
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 623-256-9074
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1054 LEESBURG ST
-----------------------------------------------------
City | LAS VEGAS
-----------------------------------------------------
State | NV
-----------------------------------------------------
Zip | 89110-2578
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 623-256-9074
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | ANJAIL LATOYA SCOTT
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 626-256-9074
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251S00000X
-----------------------------------------------------
Taxonomy Name | Community/Behavioral Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | NV
-----------------------------------------------------