Organization
MARK C. NELSON, MD, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARK C NELSON MD (PRESIDENT)
(858) 571-0606
Entity
Organization
Contact information
Practice address
9834 GENESEE AVENUE, SUITE 223, LAJOLLA, CA 92037
(858) 777-7917
(858) 703-5048
Mailing address
9834 GENESEE AVENUE, SUITE 223, LAJOLLA, CA 92037
(858) 777-7917
(858) 703-5048
Taxonomy
Speciality
Code
Description
License number
State
207XS0117X
Orthopaedic Surgery of the Spine Physician
Primary
A80416
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
W17893
MEDICARE PTAN
CA
01
—
WA80416B
MEDICARE PROVIDER ID
CA
Enumeration date
01/29/2007
Last updated
02/02/2015
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