Healthcare Provider Details

I. General information

NPI: 1104223049
Provider Name (Legal Business Name): NELSON BROWN JR.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/20/2014
Last Update Date: 08/18/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7231 BOULDER AVE SUITE 293
HIGHLAND CA
92346-3313
US

IV. Provider business mailing address

7231 BOULDER AVE SUITE 293
HIGHLAND CA
92346-3313
US

V. Phone/Fax

Practice location:
  • Phone: 909-910-8200
  • Fax:
Mailing address:
  • Phone: 909-910-8200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number46246
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number StateNULL
# 4
Primary TaxonomyY
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: