Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN1001X | Nutrition | DC16013 | CA |
NPI | 1336281641 |
---|---|
Provider Name | Dr. Michaell Keith Nelson |
First Address | San Juan Capistrano, CA 92675-6761 |
Second Address | San Juan Capistrano, CA 92675-6761 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/02/2007 |
Last Update Date | 08/07/2007 |