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General NPI Number Information
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NPI Number | 1245341601
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Entity Type | Individual
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Provider Name | MARK C NELSON MD
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Gender | Male
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Dates
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Enumeration Date | 08/31/2006
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Last Update Date | 02/02/2015
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Provider Practice Location Address
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Address Line | 9834 GENESEE AVENUE SUITE 223
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City | LAJOLLA
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State | CA
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Zip | 92037
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Country | US
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Telephone | 858-777-7917
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Fax | 858-703-5048
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Provider Business Mailing Address
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Address Line | 9834 GENESEE AVENUE SUITE 223
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City | LAJOLLA
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State | CA
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Zip | 92037
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Country | US
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Telephone | 858-777-7917
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Fax | 858-703-5048
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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 | 207XS0117X
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Taxonomy Name | Orthopaedic Surgery of the Spine Physician
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License Number | A80416
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License Number State | CA
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