Provider Demographics
NPI:1700627411
Name:SCOTT, THERESA RENEE (AS)
Entity type:Individual
Prefix:MS
First Name:THERESA
Middle Name:RENEE
Last Name:SCOTT
Suffix:
Gender:F
Credentials:AS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1121 W VALLEY BLVD STE B-C
Mailing Address - Street 2:
Mailing Address - City:TEHACHAPI
Mailing Address - State:CA
Mailing Address - Zip Code:93561-2171
Mailing Address - Country:US
Mailing Address - Phone:661-750-6289
Mailing Address - Fax:
Practice Address - Street 1:1121 W VALLEY BLVD STE B-C
Practice Address - Street 2:
Practice Address - City:TEHACHAPI
Practice Address - State:CA
Practice Address - Zip Code:93561-2171
Practice Address - Country:US
Practice Address - Phone:661-750-6289
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-05
Last Update Date:2024-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist
No172V00000XOther Service ProvidersCommunity Health Worker