Provider Demographics
NPI:1942215249
Name:NELSON, DOUGLAS (DO)
Entity Type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:
Last Name:NELSON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1202 MARICOPA HWY
Mailing Address - Street 2:STE C
Mailing Address - City:OJAI
Mailing Address - State:CA
Mailing Address - Zip Code:93023-3129
Mailing Address - Country:US
Mailing Address - Phone:805-640-0068
Mailing Address - Fax:805-640-1749
Practice Address - Street 1:1202 MARICOPA HWY
Practice Address - Street 2:STE C
Practice Address - City:OJAI
Practice Address - State:CA
Practice Address - Zip Code:93023-3129
Practice Address - Country:US
Practice Address - Phone:805-640-0068
Practice Address - Fax:805-640-1749
Is Sole Proprietor?:No
Enumeration Date:2006-07-29
Last Update Date:2008-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A4807207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR006280Medicaid
CA00AX48070Medicaid
CAGR006280Medicaid
CA00AX48070Medicaid
CAW20A4807BMedicare PIN