Provider Demographics
NPI:1174059828
Name:ARIZALA, SCOTT
Entity type:Individual
Prefix:
First Name:SCOTT
Middle Name:
Last Name:ARIZALA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:943 LENNOX ST
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48103-4529
Mailing Address - Country:US
Mailing Address - Phone:734-657-0057
Mailing Address - Fax:
Practice Address - Street 1:943 LENNOX ST
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48103-4529
Practice Address - Country:US
Practice Address - Phone:734-657-0057
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-02
Last Update Date:2017-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor