Provider Demographics
NPI:1437555646
Name:NIELSON, GREGG (RVT)
Entity Type:Individual
Prefix:
First Name:GREGG
Middle Name:
Last Name:NIELSON
Suffix:
Gender:M
Credentials:RVT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:913 LINDENCLIFF ST
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90502-2710
Mailing Address - Country:US
Mailing Address - Phone:805-705-5003
Mailing Address - Fax:
Practice Address - Street 1:4501 BIRCH ST
Practice Address - Street 2:STE C
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-1990
Practice Address - Country:US
Practice Address - Phone:805-705-5003
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-11-15
Last Update Date:2016-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1544352471V0105X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2471V0105XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistVascular Sonography