Individual
JACOB DONOVAN NELSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
15000 KENSINGTON PARK DR STE 110, TUSTIN, CA 92782-1831
(657) 859-6458
Mailing address
15000 KENSINGTON PARK DR STE 110, TUSTIN, CA 92782-1831
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
—
—
Other
Enumeration date
05/17/2024
Last updated
05/17/2024
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