Healthcare Provider Details

I. General information

NPI: 1134214471
Provider Name (Legal Business Name): NEDLEY CLINIC P C
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 11/15/2022
Certification Date: 11/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20601 W PAOLI LN
WEIMAR CA
95736
US

IV. Provider business mailing address

PO BOX 654
WEIMAR CA
95736-0654
US

V. Phone/Fax

Practice location:
  • Phone: 530-422-7920
  • Fax:
Mailing address:
  • Phone: 530-422-7920
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number16858
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number1658
License Number StateOK
# 3
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number16858
License Number StateOK

VIII. Authorized Official

Name: NEIL A NEDLEY
Title or Position: OWNER
Credential: MD
Phone: 530-422-7920