Provider Demographics
NPI:1821612854
Name:NEILSEN, BETH KRISTINE (MD, PHD)
Entity Type:Individual
Prefix:DR
First Name:BETH
Middle Name:KRISTINE
Last Name:NEILSEN
Suffix:
Gender:F
Credentials:MD, PHD
Other - Prefix:
Other - First Name:BETH
Other - Middle Name:KRISTINE
Other - Last Name:CLYMER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:200 UCLA MEDICAL PLZ STE B265
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90095-8344
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:757 WESTWOOD PLZ
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90095-2055
Practice Address - Country:US
Practice Address - Phone:310-267-5575
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-05
Last Update Date:2022-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA6812208D00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice