Healthcare Provider Details

I. General information

NPI: 1366069023
Provider Name (Legal Business Name): MISCHELLE NELSON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2020
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12052 IMPERIAL HWY STE 102
NORWALK CA
90650-3091
US

IV. Provider business mailing address

12052 IMPERIAL HWY STE 102
NORWALK CA
90650-3091
US

V. Phone/Fax

Practice location:
  • Phone: 562-261-9330
  • Fax: 562-543-3134
Mailing address:
  • Phone: 562-261-9330
  • Fax: 562-543-3031

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA192197
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: