Healthcare Provider Details

I. General information

NPI: 1568372696
Provider Name (Legal Business Name): ADRIAN JOSEPH NELSON
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

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

III. Provider practice location address

32295 MISSION TRL STE R9
LAKE ELSINORE CA
92530-4543
US

IV. Provider business mailing address

31300 AUTO CENTER DR APT H134
LAKE ELSINORE CA
92530-4540
US

V. Phone/Fax

Practice location:
  • Phone: 951-349-6861
  • Fax:
Mailing address:
  • Phone: 951-349-6861
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number95665
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: