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General NPI Number Information
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NPI Number | 1194090423
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Entity Type | Organization
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Legal Business Name | SCOTT E NELSON MD A MEDICAL CORPORATION
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Dates
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Enumeration Date | 03/20/2012
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Last Update Date | 03/20/2012
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Provider Practice Location Address
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Address Line | 612 W DUARTE RD SUITE 404
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City | ARCADIA
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State | CA
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Zip | 91007-7602
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Country | US
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Telephone | 636-445-3900
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Fax |
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Provider Business Mailing Address
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Address Line | 612 W DUARTE RD SUITE 404
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City | ARCADIA
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State | CA
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Zip | 91007-7602
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Country | US
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Telephone | 636-445-3900
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Fax |
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Authorized Official
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Title or Position | PHYSICIAN
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Name | DR. SCOTT E NELSON
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Credential | MD
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Telephone | 626-445-3900
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | G30870
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License Number State | CA
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