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Individual
MR. ROGE DEANPAUL NELSON
Active
Individual
MR. ROGE DEANPAUL NELSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
27BW8
MEDI-CAL PRV NBR
CA
01
—
D6709194
DRIVER'S LICENSE
CA
Enumeration date
07/09/2009
Last updated
07/09/2009
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