MEDICARE: DR. RICHARD MALACHI SCOTT PHD

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	103TC0700X	Clinical Psychologist	PSY19143	CA

General Provider Information

NPI Number	:	1821110727
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RICHARD MALACHI SCOTT PHD

Provider Business Mailing Address
First Line	:	11672 RAMSDELL CT
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92131-3607
Country	:	US
Telephone Number	:	619-405-6422
Fax Number	:

Provider Business Practice Location Address
First Line	:	10755 SCRIPPS POWAY PKWY
Second Line	:	STE #173
City	:	SAN DIEGO
State	:	CA
Zip	:	92131-3924
Country	:	US
Telephone Number	:	619-405-6422
Fax Number	:

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

Provider Enumeration Date	:	04/04/2007
Last Update Date	:	07/08/2007

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