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General NPI Number Information
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NPI Number | 1912102161
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Entity Type | Organization
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Legal Business Name | UC REGENTS SURGERY LASER UNIVERSITY PHY
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Dates
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Enumeration Date | 06/18/2007
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Last Update Date | 07/11/2008
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Provider Practice Location Address
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Address Line | 1002 HEALTH SCIENCES RD EAST
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City | IRVINE
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State | CA
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Zip | 92612-3010
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Country | US
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Telephone | 949-824-4269
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Fax | 949-824-2726
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Provider Business Mailing Address
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Address Line | PO BOX 513375
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City | LOS ANGELES
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State | CA
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Zip | 90051-3375
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Country | US
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Telephone | 949-824-4269
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Fax | 949-824-2726
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. JOHN S NELSON
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Credential | M.D
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Telephone | 949-824-7526
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number |
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License Number State | CA
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