Provider Demographics
NPI:1770089757
Name:ELY, NICHOLAS WESLEY (MD)
Entity type:Individual
Prefix:MR
First Name:NICHOLAS
Middle Name:WESLEY
Last Name:ELY
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:31537 RANCHO PUEBLO RD STE 102
Mailing Address - Street 2:
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92592-4841
Mailing Address - Country:US
Mailing Address - Phone:760-291-6700
Mailing Address - Fax:951-294-9039
Practice Address - Street 1:26001 REDLANDS BLVD
Practice Address - Street 2:
Practice Address - City:REDLANDS
Practice Address - State:CA
Practice Address - Zip Code:92373-7762
Practice Address - Country:US
Practice Address - Phone:909-825-7084
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-30
Last Update Date:2023-12-22
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CA174039207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine