Provider Demographics
NPI:1033202437
Name:NELSON, RENEE MARLEEN (MD)
Entity Type:Individual
Prefix:
First Name:RENEE
Middle Name:MARLEEN
Last Name:NELSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9850 GENESEE AVE
Mailing Address - Street 2:#60
Mailing Address - City:LA JOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92037
Mailing Address - Country:US
Mailing Address - Phone:858-453-0753
Mailing Address - Fax:858-642-4270
Practice Address - Street 1:9850 GENESEE AVE
Practice Address - Street 2:#60
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92037
Practice Address - Country:US
Practice Address - Phone:858-453-0753
Practice Address - Fax:858-642-4270
Is Sole Proprietor?:No
Enumeration Date:2006-09-30
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA79495207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA79495OtherMED BOARD
CAA79495OtherMED BOARD
H76687Medicare UPIN