Provider Demographics
NPI:1043848872
Name:NELSON MD AND LOCHHEAD MD, A PROFESSIONAL MEDICAL CORPORATION
Entity Type:Organization
Organization Name:NELSON MD AND LOCHHEAD MD, A PROFESSIONAL MEDICAL CORPORATION
Other - Org Name:NELSON MD AND LOCHHEAD MD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHELE
Authorized Official - Middle Name:
Authorized Official - Last Name:NELSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:949-236-7223
Mailing Address - Street 1:28202 CABOT RD STE 635
Mailing Address - Street 2:
Mailing Address - City:LAGUNA NIGUEL
Mailing Address - State:CA
Mailing Address - Zip Code:92677-1222
Mailing Address - Country:US
Mailing Address - Phone:949-236-7223
Mailing Address - Fax:
Practice Address - Street 1:28202 CABOT RD STE 635
Practice Address - Street 2:
Practice Address - City:LAGUNA NIGUEL
Practice Address - State:CA
Practice Address - Zip Code:92677-1222
Practice Address - Country:US
Practice Address - Phone:203-482-7227
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-28
Last Update Date:2021-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent PsychiatryGroup - Multi-Specialty