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NPI Code Detail

MEDICARE: WESLEY NELSON

MEDICARE: WESLEY NELSON
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
1106S00000XBehavior TechnicianCA

General Provider Information

NPI Number : 1104776715
Entity Type Code : Individual
Provider Name (Legal Business Name) : WESLEY NELSON
Provider Business Mailing Address
First Line : 119 W TORRANCE BLVD STE 100
Second Line :
City : REDONDO BEACH
State : CA
Zip : 90277-3600
Country : US
Telephone Number : 310-374-3300
Fax Number :
Provider Business Practice Location Address
First Line : 3280 MOTOR AVE STE 110
Second Line :
City : LOS ANGELES
State : CA
Zip : 90034-3766
Country : US
Telephone Number : 424-672-6700
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/02/2026
Last Update Date : 02/02/2026

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Directions to “ WESLEY NELSON ” Practice Location

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