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General NPI Number Information
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NPI Number | 1396142311
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Entity Type | Individual
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Provider Name | GREGORY CLIFFORD NELSON P.A.
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Gender | Male
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Dates
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Enumeration Date | 11/20/2014
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Last Update Date | 11/20/2014
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Provider Practice Location Address
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Address Line | 101 BODIN CIR
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City | TRAVIS AFB
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State | CA
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Zip | 94535-1809
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Country | US
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Telephone | 707-423-7611
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Fax |
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Provider Business Mailing Address
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Address Line | 2713 MANZANO
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City | MISSION VIEJO
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State | CA
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Zip | 92692
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Country | US
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Telephone | 949-412-7695
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 1121110
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License Number State | CA
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