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General NPI Number Information
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NPI Number | 1811185747
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Entity Type | Organization
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Legal Business Name | NELSON-NAM A MEDICAL CORPORATION
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Dates
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Enumeration Date | 10/04/2007
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Last Update Date | 07/18/2015
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Provider Practice Location Address
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Address Line | 15243 VANOWEN ST SUITE 212
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City | VAN NUYS
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State | CA
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Zip | 91405-3605
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Country | US
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Telephone | 818-785-8707
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Fax | 818-785-1152
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Provider Business Mailing Address
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Address Line | PO BOX 55637
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City | SHERMAN OAKS
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State | CA
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Zip | 91413-0637
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Country | US
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Telephone | 818-785-8707
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Fax | 818-785-1152
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Authorized Official
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Title or Position | OWNER
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Name | DR. GREG J NELSON
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Credential | M.D.
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Telephone | 818-785-8707
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number |
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License Number State |
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