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NPI Code Detail

MEDICARE: SCOTT ELLIS MCCLURE

MEDICARE: SCOTT ELLIS MCCLURE
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
1104100000XSocial Worker

General Provider Information

NPI Number : 1669550612
Entity Type Code : Individual
Provider Name (Legal Business Name) : SCOTT ELLIS MCCLURE
Provider Business Mailing Address
First Line : 4522 UTAH ST APT 6
Second Line :
City : SAN DIEGO
State : CA
Zip : 92116-5117
Country : US
Telephone Number : 619-248-3912
Fax Number :
Provider Business Practice Location Address
First Line : 140 ARBOR DR
Second Line :
City : SAN DIEGO
State : CA
Zip : 92103-2007
Country : US
Telephone Number : 619-299-3510
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/01/2006
Last Update Date : 07/08/2007

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Directions to “ SCOTT ELLIS MCCLURE ” Practice Location

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