Individual
BRADLEY WIMMER NELSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
6405 DAY ST, RIVERSIDE, CA 92507-0901
(951) 697-5455
(951) 653-3975
Mailing address
3660 ARLINGTON AVE, RIVERSIDE, CA 92506-3912
(951) 782-5110
(951) 274-0403
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
G52306
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
ZZZ92058Z
GROUP SITE LOCATION
—
Enumeration date
11/23/2005
Last updated
12/29/2010
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