Healthcare Provider Details

I. General information

NPI: 1285696278
Provider Name (Legal Business Name): SCOTT R NELSON D.O., FACEP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/05/2006
Last Update Date: 03/26/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24361 EL TORO RD SUITE 120
LAGUNA WOODS CA
92637-2755
US

IV. Provider business mailing address

24361 EL TORO RD SUITE 120
LAGUNA WOODS CA
92637-2755
US

V. Phone/Fax

Practice location:
  • Phone: 949-916-6321
  • Fax: 949-916-6340
Mailing address:
  • Phone: 949-916-6321
  • Fax: 949-916-6340

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberG3643
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code207PE0005X
TaxonomyUndersea and Hyperbaric Medicine (Emergency Medicine) Physician
License NumberG3643
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code2083P0500X
TaxonomyPreventive Medicine/Occupational Environmental Medicine Physician
License NumberG3643
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: