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General NPI Number Information
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NPI Number | 1598465502
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Entity Type | Individual
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Provider Name | BRANDON BERTRILLE SCOTT
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Gender | Female
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Dates
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Enumeration Date | 03/08/2023
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Last Update Date | 03/08/2023
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Provider Practice Location Address
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Address Line | 4119 PRESIDENTS DR S.
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City | HOUSTON
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State | TX
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Zip | 77047
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Country | US
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Telephone | 832-865-9559
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Fax | 832-740-4045
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Provider Business Mailing Address
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Address Line | 4119 PRESIDENTS DR S
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City | HOUSTON
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State | TX
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Zip | 77047-6763
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Country | US
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Telephone | 832-865-9559
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Fax | 832-740-4045
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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 | 347C00000X
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Taxonomy Name | Private Vehicle
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License Number | 15133413
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License Number State | TX
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