Provider Demographics
NPI:1629009139
Name:NELSON, ANITA L (MD)
Entity Type:Individual
Prefix:
First Name:ANITA
Middle Name:L
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 1:21840 NORMANDIE AVE
Mailing Address - Street 2:STE. 1100
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90502-2047
Mailing Address - Country:US
Mailing Address - Phone:310-222-5125
Mailing Address - Fax:310-328-5731
Practice Address - Street 1:21840 NORMANDIE AVE
Practice Address - Street 2:STE. 1100
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90502-2047
Practice Address - Country:US
Practice Address - Phone:310-222-5125
Practice Address - Fax:310-328-5731
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2009-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG49311207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADA6447OtherRAILROAD MEDICARE
CAW14940OtherGROUP
CAP00686006OtherRAILROAD PTAN
CA00A493110Medicaid
CACH1382OtherRAILROAD MEDICARE
CAM050376OtherGROUP
CAWG49311CMedicare PIN
CAW14940OtherGROUP
CADA6447OtherRAILROAD MEDICARE
CAWG43911EMedicare PIN