Healthcare Provider Details

I. General information

NPI: 1427093756
Provider Name (Legal Business Name): LISA N NELMS D.P.M
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/19/2006
Last Update Date: 02/02/2021
Certification Date: 02/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2030 VIBORG RD STE 104
SOLVANG CA
93463-3224
US

IV. Provider business mailing address

1031 MIRAMONTE DR APT 6
SANTA BARBARA CA
93109-1327
US

V. Phone/Fax

Practice location:
  • Phone: 805-686-3961
  • Fax: 805-733-1213
Mailing address:
  • Phone: 805-733-4869
  • Fax: 805-733-1213

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License NumberE4325
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: