Healthcare Provider Details

I. General information

NPI: 1215910120
Provider Name (Legal Business Name): RHETT BARRY NELSON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/23/2005
Last Update Date: 03/17/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6405 DAY ST
RIVERSIDE CA
92507-0901
US

IV. Provider business mailing address

3660 ARLINGTON AVE
RIVERSIDE CA
92506-3912
US

V. Phone/Fax

Practice location:
  • Phone: 951-697-5570
  • Fax: 951-697-5596
Mailing address:
  • Phone: 951-697-5570
  • Fax: 951-697-5596

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License NumberG19117
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: