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General NPI Number Information
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NPI Number | 1851651400
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Entity Type | Organization
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Legal Business Name | LINDA D. NELSON, PH.D., ABPN, INC.
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Dates
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Enumeration Date | 05/16/2012
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Last Update Date | 05/16/2012
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Provider Practice Location Address
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Address Line | 1137 2ND ST STE 101
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City | SANTA MONICA
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State | CA
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Zip | 90403-5068
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Country | US
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Telephone | 310-458-4581
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Fax |
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Provider Business Mailing Address
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Address Line | 1137 2ND ST STE 101
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City | SANTA MONICA
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State | CA
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Zip | 90403-5068
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Country | US
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Telephone | 310-458-4581
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. LINDA D NELSON
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Credential | PH.D., ABPN
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Telephone | 310-458-4581
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103G00000X
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Taxonomy Name | Clinical Neuropsychologist
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License Number | PSY10688
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License Number State | CA
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