Healthcare Provider Details

I. General information

NPI: 1992134688
Provider Name (Legal Business Name): STANLEY F NELSON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/04/2013
Last Update Date: 07/06/2023
Certification Date: 07/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10833 LE CONTE AVE
LOS ANGELES CA
90095-3075
US

IV. Provider business mailing address

695 CHARLES E YOUNG DR S
LOS ANGELES CA
90095-7088
US

V. Phone/Fax

Practice location:
  • Phone: 310-206-6581
  • Fax: 310-794-5446
Mailing address:
  • Phone: 310-991-2635
  • Fax: 310-794-5446

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberG65639
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: