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General NPI Number Information
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NPI Number | 1780752659
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Entity Type | Organization
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Legal Business Name | FULLERTON GYN ASSOC.
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Dates
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Enumeration Date | 12/01/2006
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Last Update Date | 04/12/2011
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Provider Practice Location Address
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Address Line | 301 W BASTANCHURY RD #170
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City | FULLERTON
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State | CA
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Zip | 92835-3419
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Country | US
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Telephone | 714-879-6571
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Fax | 714-446-9140
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Provider Business Mailing Address
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Address Line | 301 W BASTANCHURY RD #170
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City | FULLERTON
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State | CA
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Zip | 92835-3419
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Country | US
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Telephone | 714-879-6571
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Fax | 714-446-9140
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Authorized Official
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Title or Position | OWNER- CEO
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Name | DR. NATHAN E SCOTT
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Credential | MD
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Telephone | 714-879-6571
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207VG0400X
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Taxonomy Name | Gynecology Physician
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License Number | G5122
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License Number State | CA
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