=====================================================
General NPI Number Information
=====================================================
NPI Number | 1497126189
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CYNTHIA CAROLINE SCAGGS
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/07/2015
-----------------------------------------------------
Last Update Date | 10/07/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2821 OCEANSIDE BLVD
-----------------------------------------------------
City | OCEANSIDE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92054-4800
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 760-721-2781
-----------------------------------------------------
Fax | 760-721-9571
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 593 BERRYHILL DR
-----------------------------------------------------
City | SAN MARCOS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92069-2002
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 760-535-9760
-----------------------------------------------------
Fax | 760-744-6657
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YA0400X
-----------------------------------------------------
Taxonomy Name | Addiction (Substance Use Disorder) Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------