Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XS0117X | Orthopaedic Spine Surgeon | A80416 | CA |
NPI | 1245341601 |
---|---|
Provider Name | Mark C Nelson |
First Address | Lajolla, CA 92037 |
Second Address | Lajolla, CA 92037 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 31/08/2006 |
Last Update Date | 02/02/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
H75303 | (02) | CA |