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NPI Code Detail

MEDICARE: DR. JEREMIAH JAMES NIELSON DO

MEDICARE:  DR. JEREMIAH JAMES NIELSON  DO
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
12080N0001XNeonatal-Perinatal Medicine PhysicianO-1943ID
22080N0001XNeonatal-Perinatal Medicine Physician20A10873CA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
120A10873OTHERCACA STATE MEDICAL LICENSE

General Provider Information

NPI Number : 1699891374
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JEREMIAH JAMES NIELSON DO
Provider Business Mailing Address
First Line : 2020 ZONAL AVE
Second Line : IRD# 820
City : LOS ANGELES
State : CA
Zip : 90089-0121
Country : US
Telephone Number : 323-226-3406
Fax Number : 323-226-3440
Provider Business Practice Location Address
First Line : 2020 ZONAL AVE
Second Line : IRD# 820
City : LOS ANGELES
State : CA
Zip : 90089-0121
Country : US
Telephone Number : 323-226-3406
Fax Number : 323-226-3440
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/22/2007
Last Update Date : 04/11/2024

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Directions to “ DR. JEREMIAH JAMES NIELSON DO” Practice Location

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