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General NPI Number Information
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NPI Number | 1164905782
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Entity Type | Individual
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Provider Name | GEORGE LEONARD NELSON MD
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Gender | Male
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Dates
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Enumeration Date | 09/10/2018
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Last Update Date | 09/10/2018
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Provider Practice Location Address
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Address Line | 75582 CAMINO DE PLATA N
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City | INDIAN WELLS
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State | CA
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Zip | 92210-8519
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Country | US
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Telephone | 760-674-7001
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 4401
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City | PALM DESERT
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State | CA
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Zip | 92261-4401
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Country | US
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Telephone | 760-674-7001
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207QA0505X
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Taxonomy Name | Adult Medicine Physician
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License Number | C31229
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License Number State | CA
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