Healthcare Provider Details

I. General information

NPI: 1720604515
Provider Name (Legal Business Name): NELSON HORSLEY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2020
Last Update Date: 09/21/2026
Certification Date: 09/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

290 N D ST STE 700
SAN BERNARDINO CA
92401-1705
US

IV. Provider business mailing address

1447 MOORE ST
REDLANDS CA
92374-5058
US

V. Phone/Fax

Practice location:
  • Phone: 603-521-5219
  • Fax: 603-521-5219
Mailing address:
  • Phone: 603-521-5219
  • Fax: 909-710-9205

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number187355
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: