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NPI Code Detail

MEDICARE: RYLEE HANNAH NELSEN I

MEDICARE: RYLEE HANNAH NELSEN I
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1390200000XStudent in an Organized Health Care Education/Training ProgramCA

General Provider Information

NPI Number : 1023688587
Entity Type Code : Individual
Provider Name (Legal Business Name) : RYLEE HANNAH NELSEN I
Provider Business Mailing Address
First Line : 2394 W JEWETT ST
Second Line :
City : SAN DIEGO
State : CA
Zip : 92111-6020
Country : US
Telephone Number : 303-807-0064
Fax Number :
Provider Business Practice Location Address
First Line : 9055 BALBOA AVE
Second Line :
City : SAN DIEGO
State : CA
Zip : 92123-1509
Country : US
Telephone Number : 619-849-3331
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/28/2021
Last Update Date : 09/04/2025

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Directions to “ RYLEE HANNAH NELSEN I ” Practice Location

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