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NPI Code Detail

MEDICARE: NELSEN WILLIAM YOUNG SFIDC

MEDICARE: NELSEN WILLIAM YOUNG SFIDC
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
11710I1002XIndependent Duty Corpsman

General Provider Information

NPI Number : 1174039978
Entity Type Code : Individual
Provider Name (Legal Business Name) : NELSEN WILLIAM YOUNG SFIDC
Provider Business Mailing Address
First Line : 790 CAMINO DE LA REINA APT 360
Second Line :
City : SAN DIEGO
State : CA
Zip : 92108-3270
Country : US
Telephone Number : 661-718-9201
Fax Number :
Provider Business Practice Location Address
First Line : 206 NEPTUNE STREET
Second Line :
City : SAN DIEGO
State : CA
Zip : 92155-5136
Country : US
Telephone Number : 619-537-3371
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/17/2017
Last Update Date : 12/08/2023

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