Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207L00000X | Anesthesiologist | C34999 | CA |
NPI | 1013288323 |
---|---|
Provider Name | Dr. William Lowell Nelson JR. |
First Address | Poway, CA 92064-1608 |
Second Address | Poway, CA 92064-1608 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/01/2012 |
Last Update Date | 18/01/2012 |