Provider Demographics
NPI:1134427594
Name:GELVEZON, NANI (DO)
Entity type:Individual
Prefix:
First Name:NANI
Middle Name:
Last Name:GELVEZON
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2372 MORSE AVE STE 325
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92614-6234
Mailing Address - Country:US
Mailing Address - Phone:213-357-4468
Mailing Address - Fax:
Practice Address - Street 1:600 N GARFIELD AVE STE 210
Practice Address - Street 2:
Practice Address - City:MONTEREY PARK
Practice Address - State:CA
Practice Address - Zip Code:91754-1170
Practice Address - Country:US
Practice Address - Phone:626-573-8282
Practice Address - Fax:626-573-8338
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-09
Last Update Date:2021-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036136051208600000X
CA20A11327208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery