Most Relevant Information
Provider Data
| NPI Number: | 1003598608 |
| Provider Name: | BRYNNA SCOUT FULLERTON VERGARA |
| Entity Type: | Individual |
| Taxonomy Code: | 207ZC0006X |
| Specialty: | Pathology |
| License Number: | SLPA14693 |
Most Important Dates
| Enumeration Date: | 08/02/2023 |
| Last Updated: | 08/02/2023 |
Provider Practice Location
101 S AIRPARK RD
COTTONWOOD
AZ
863264182
Practice Location Phone/Fax
| Phone: | 9286392694 |
| Fax: |
Provider Mailing Location
101 AIRPARK ROAD
SUITE M
COTTONWOOD
AZ
86326
Provider Mailing Phone/Fax
| Phone: | 9286392694 |
| Fax: |