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Individual

BENJAMIN MATHEW NELSON

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man

Contact information

Practice address
8831 VENICE BLVD, LOS ANGELES, CA 90034-3223
(310) 484-8929
Mailing address
8831 VENICE BLVD, LOS ANGELES, CA 90034-3223
(310) 484-8929

Taxonomy

Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
CA

Other

Enumeration date
04/03/2024
Last updated
04/03/2024
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