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General NPI Number Information
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NPI Number | 1730702630
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Entity Type | Individual
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Provider Name | RYAN ANDREW NELSON MD, MPH, DIPABPM
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Gender | Male
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Dates
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Enumeration Date | 05/26/2020
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Last Update Date | 12/21/2024
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Provider Practice Location Address
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Address Line | 11201 BENTON ST
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City | LOMA LINDA
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State | CA
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Zip | 92357-2800
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Country | US
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Telephone | 909-825-7084
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Fax |
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Provider Business Mailing Address
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Address Line | 2140 MENTONE BLVD SPC 84
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City | MENTONE
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State | CA
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Zip | 92359-9688
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Country | US
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Telephone |
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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 | 2083P0901X
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Taxonomy Name | Public Health & General Preventive Medicine Physician
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License Number | A187424
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License Number State | CA
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