Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | A20625 | CA |
NPI | 1003092503 |
---|---|
Provider Name | Dr. Robert L Nelson |
First Address | Garden Grove, CA 92843-1917 |
Second Address | Garden Grove, CA 92843-1917 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/01/2008 |
Last Update Date | 15/01/2008 |