Provider Demographics
NPI:1386913531
Name:SCOTT, ZONDREE ARQUETTA (PA-C)
Entity type:Individual
Prefix:MS
First Name:ZONDREE
Middle Name:ARQUETTA
Last Name:SCOTT
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10382 SHAHAPTAIN AVE
Mailing Address - Street 2:
Mailing Address - City:HESPERIA
Mailing Address - State:CA
Mailing Address - Zip Code:92345-7703
Mailing Address - Country:US
Mailing Address - Phone:760-947-5070
Mailing Address - Fax:
Practice Address - Street 1:12565 HESPERIA RD
Practice Address - Street 2:SUITE 1
Practice Address - City:VICTORVILLE
Practice Address - State:CA
Practice Address - Zip Code:92395-8318
Practice Address - Country:US
Practice Address - Phone:760-881-3377
Practice Address - Fax:760-881-3379
Is Sole Proprietor?:No
Enumeration Date:2011-12-16
Last Update Date:2011-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA11977363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant