Provider Demographics
NPI:1821667882
Name:NELMIDA, JOHN
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:NELMIDA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 S HUMBOLDT ST
Mailing Address - Street 2:
Mailing Address - City:SAN MATEO
Mailing Address - State:CA
Mailing Address - Zip Code:94401-2935
Mailing Address - Country:US
Mailing Address - Phone:209-361-4906
Mailing Address - Fax:
Practice Address - Street 1:201 S HUMBOLDT ST
Practice Address - Street 2:
Practice Address - City:SAN MATEO
Practice Address - State:CA
Practice Address - Zip Code:94401-2935
Practice Address - Country:US
Practice Address - Phone:209-361-4906
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-23
Last Update Date:2021-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist