Healthcare Provider Details

I. General information

NPI: 1831883883
Provider Name (Legal Business Name): NICHOLAS CHARLES NELSON DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2023
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2126 SHAW AVE
CLOVIS CA
93611-8919
US

IV. Provider business mailing address

PO BOX 889442
LOS ANGELES CA
90088-9442
US

V. Phone/Fax

Practice location:
  • Phone: 559-387-2150
  • Fax: 559-387-2155
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number20A25909
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: