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NPI Code Detail

MEDICARE: TONYA NELSON

MEDICARE: TONYA 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
1247200000XOther TechnicianPT26756CA
2167G00000XLicensed Psychiatric TechnicianPT26756CA

General Provider Information

NPI Number : 1932483385
Entity Type Code : Individual
Provider Name (Legal Business Name) : TONYA NELSON
Provider Business Mailing Address
First Line : 4545 GEORGETOWN PL STE A3
Second Line :
City : STOCKTON
State : CA
Zip : 95207-6228
Country : US
Telephone Number : 209-280-2362
Fax Number :
Provider Business Practice Location Address
First Line : 4545 GEORGETOWN PL STE A3
Second Line :
City : STOCKTON
State : CA
Zip : 95207-6228
Country : US
Telephone Number : 209-280-2362
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/04/2011
Last Update Date : 07/03/2024

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