Healthcare Provider Details

I. General information

NPI: 1356269542
Provider Name (Legal Business Name): CHRISTINE CAROLE NELSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2026
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27188 SUN CITY BLVD
MENIFEE CA
92586-5505
US

IV. Provider business mailing address

3 CLEMENT PL
MERRIMAC MA
01860-1850
US

V. Phone/Fax

Practice location:
  • Phone: 951-679-1661
  • Fax:
Mailing address:
  • Phone: 978-935-6090
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number113213
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: