Healthcare Provider Details

I. General information

NPI: 1952656852
Provider Name (Legal Business Name): MINERVA NELSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MINERVA HUERTA

II. Dates (important events)

Enumeration Date: 07/17/2012
Last Update Date: 07/17/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

41945 BIG BEAR BLVD
BIG BEAR LAKE CA
92315
US

IV. Provider business mailing address

PO BOX 1927
BIG BEAR LAKE CA
92315-1927
US

V. Phone/Fax

Practice location:
  • Phone: 909-866-5070
  • Fax: 909-877-3228
Mailing address:
  • Phone: 909-866-5070
  • Fax: 909-878-3228

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: