MEDICARE: KRISTAL CHERIE 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	106S00000X	Behavior Technician

General Provider Information

NPI Number	:	1740797406
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTAL CHERIE SCOTT

Provider Business Mailing Address
First Line	:	16996 CAMINITO SANTICO
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92128-2307
Country	:	US
Telephone Number	:	714-262-3826
Fax Number	:

Provider Business Practice Location Address
First Line	:	5080 SHOREHAM PL STE 103
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92122-5931
Country	:	US
Telephone Number	:	858-272-2662
Fax Number	:

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

Provider Enumeration Date	:	01/03/2018
Last Update Date	:	01/03/2018

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Directions to “ KRISTAL CHERIE SCOTT ” Practice Location

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