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NPI Code Detail

MEDICARE: NELSON C. BAXLEY

MEDICARE: NELSON C. BAXLEY
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
1101YP2500XProfessional Counselor0H96944CA

General Provider Information

NPI Number : 1912742826
Entity Type Code : Individual
Provider Name (Legal Business Name) : NELSON C. BAXLEY
Provider Business Mailing Address
First Line : 2451 W HOLT AVE
Second Line :
City : EL CENTRO
State : CA
Zip : 92243-3543
Country : US
Telephone Number : 415-793-6415
Fax Number :
Provider Business Practice Location Address
First Line : 2451 W HOLT AVE
Second Line :
City : EL CENTRO
State : CA
Zip : 92243-3543
Country : US
Telephone Number : 415-793-6415
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/01/2024
Last Update Date : 07/01/2024

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Directions to “ NELSON C. BAXLEY ” Practice Location

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