Provider Demographics
NPI:1992786347
Name:SCOTT, DIANE M (MD)
Entity type:Individual
Prefix:
First Name:DIANE
Middle Name:M
Last Name:SCOTT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:15611 POMERADO RD
Mailing Address - Street 2:SUITE 400
Mailing Address - City:POWAY
Mailing Address - State:CA
Mailing Address - Zip Code:92064-2437
Mailing Address - Country:US
Mailing Address - Phone:858-675-3145
Mailing Address - Fax:858-385-7855
Practice Address - Street 1:15611 POMERADO RD
Practice Address - Street 2:SUITE 400
Practice Address - City:POWAY
Practice Address - State:CA
Practice Address - Zip Code:92064-2437
Practice Address - Country:US
Practice Address - Phone:858-675-3145
Practice Address - Fax:858-385-7855
Is Sole Proprietor?:No
Enumeration Date:2005-11-10
Last Update Date:2014-08-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME82439207N00000X, 207ND0900X
CA129874207N00000X, 207ND0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207ND0900XAllopathic & Osteopathic PhysiciansDermatologyDermatopathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL51314ZMedicare PIN
H44566Medicare UPIN