Provider Demographics
NPI:1760706253
Name:NORMAN H NELSON M.D., A MEDICAL CORP
Entity Type:Organization
Organization Name:NORMAN H NELSON M.D., A MEDICAL CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NORMAN
Authorized Official - Middle Name:H
Authorized Official - Last Name:NELSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-789-0533
Mailing Address - Street 1:5400 BALBOA BLVD
Mailing Address - Street 2:SUITE 141
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91316-5203
Mailing Address - Country:US
Mailing Address - Phone:818-789-0533
Mailing Address - Fax:818-789-7642
Practice Address - Street 1:5400 BALBOA BLVD
Practice Address - Street 2:SUITE 141
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91316-5203
Practice Address - Country:US
Practice Address - Phone:818-789-0533
Practice Address - Fax:818-789-7642
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-26
Last Update Date:2011-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA16140207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
A20404Medicare UPIN