Provider Demographics
NPI:1235343294
Name:ANTHONY NELSON MD A MEDICAL CORPORATION
Entity Type:Organization
Organization Name:ANTHONY NELSON MD A MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TIFFANY
Authorized Official - Middle Name:
Authorized Official - Last Name:FALKEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-244-8505
Mailing Address - Street 1:PO BOX 2757
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92859-0757
Mailing Address - Country:US
Mailing Address - Phone:714-973-2650
Mailing Address - Fax:714-973-2655
Practice Address - Street 1:71780 SAN JACINTO DR STE B1
Practice Address - Street 2:
Practice Address - City:RANCHO MIRAGE
Practice Address - State:CA
Practice Address - Zip Code:92270-5517
Practice Address - Country:US
Practice Address - Phone:760-202-1919
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-09
Last Update Date:2023-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG61216207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAE67215Medicare UPIN
00G612160Medicare ID - Type Unspecified