Provider Demographics
NPI:1598116691
Name:CHEN, NELSON (ATC)
Entity Type:Individual
Prefix:
First Name:NELSON
Middle Name:
Last Name:CHEN
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 PIERRE RD
Mailing Address - Street 2:
Mailing Address - City:WALNUT
Mailing Address - State:CA
Mailing Address - Zip Code:91789-2535
Mailing Address - Country:US
Mailing Address - Phone:909-594-1333
Mailing Address - Fax:909-595-4440
Practice Address - Street 1:400 PIERRE RD
Practice Address - Street 2:
Practice Address - City:WALNUT
Practice Address - State:CA
Practice Address - Zip Code:91789-2535
Practice Address - Country:US
Practice Address - Phone:909-594-1333
Practice Address - Fax:909-595-4440
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-29
Last Update Date:2016-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer