MEDICARE: JASON SCOTT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	172V00000X	Community Health Worker

General Provider Information

NPI Number	:	1215586250
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JASON SCOTT

Provider Business Mailing Address
First Line	:	500 W QUEEN ST APT 9
Second Line	:
City	:	INGLEWOOD
State	:	CA
Zip	:	90301-4767
Country	:	US
Telephone Number	:	310-946-8921
Fax Number	:

Provider Business Practice Location Address
First Line	:	3816 VIRGINIA RD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90008-1809
Country	:	US
Telephone Number	:	310-946-8921
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/11/2019
Last Update Date	:	09/11/2019

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Directions to “ JASON SCOTT ” Practice Location

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