Healthcare Provider Details

I. General information

NPI: 1043848872
Provider Name (Legal Business Name): NELSON MD AND LOCHHEAD MD, A PROFESSIONAL MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/28/2020
Last Update Date: 09/16/2021
Certification Date: 09/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28202 CABOT RD STE 635
LAGUNA NIGUEL CA
92677-1222
US

IV. Provider business mailing address

28202 CABOT RD STE 635
LAGUNA NIGUEL CA
92677-1222
US

V. Phone/Fax

Practice location:
  • Phone: 203-482-7227
  • Fax:
Mailing address:
  • Phone: 949-236-7223
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. MICHELE NELSON
Title or Position: PRESIDENT
Credential: MD
Phone: 949-236-7223