Healthcare Provider Details

I. General information

NPI: 1669804241
Provider Name (Legal Business Name): DR. A NELSON EL AMIN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/06/2013
Last Update Date: 09/07/2022
Certification Date: 09/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4921 INADALE AVE
LOS ANGELES CA
90043-1550
US

IV. Provider business mailing address

4921 INADALE AVE
LOS ANGELES CA
90043-1550
US

V. Phone/Fax

Practice location:
  • Phone: 213-351-7404
  • Fax:
Mailing address:
  • Phone: 213-351-7404
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberG30088
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: