Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QA0505X | Family Doctor - Adult Medicine | C31229 | CA |
NPI | 1164905782 |
---|---|
Provider Name | George Leonard Nelson |
First Address | Palm Desert, CA 92261-4401 |
Second Address | Indian Wells, CA 92210-8519 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/09/2018 |
Last Update Date | 10/09/2018 |