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General NPI Number Information
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NPI Number | 1437555646
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Entity Type | Individual
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Provider Name | GREGG NIELSON RVT
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Gender | Male
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Dates
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Enumeration Date | 11/15/2014
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Last Update Date | 08/17/2016
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Provider Practice Location Address
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Address Line | 4501 BIRCH ST STE C
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City | NEWPORT BEACH
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State | CA
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Zip | 92660-1990
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Country | US
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Telephone | 805-705-5003
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Fax |
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Provider Business Mailing Address
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Address Line | 913 LINDENCLIFF ST
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City | TORRANCE
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State | CA
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Zip | 90502-2710
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Country | US
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Telephone | 805-705-5003
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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 | 2471V0105X
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Taxonomy Name | Vascular Sonography Radiologic Technologist
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License Number | 154435
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License Number State | CA
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