Provider Demographics
NPI:1013372291
Name:NELSON OWYOUNG
Entity Type:Organization
Organization Name:NELSON OWYOUNG
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:
Authorized Official - Last Name:GALVAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:626-570-4708
Mailing Address - Street 1:1048 S GARFIELD AVE STE 202
Mailing Address - Street 2:
Mailing Address - City:ALHAMBRA
Mailing Address - State:CA
Mailing Address - Zip Code:91801-4768
Mailing Address - Country:US
Mailing Address - Phone:626-570-4708
Mailing Address - Fax:626-570-4348
Practice Address - Street 1:1048 S GARFIELD AVE STE 202
Practice Address - Street 2:
Practice Address - City:ALHAMBRA
Practice Address - State:CA
Practice Address - Zip Code:91801-4768
Practice Address - Country:US
Practice Address - Phone:626-570-4708
Practice Address - Fax:626-570-4348
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-15
Last Update Date:2015-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA40475305S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAE79771Medicare UPIN