Basic Information
| Provider Information | |||||||||
| NPI: | 1144238205 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | NELSON E KOE MD A PROFESSIONAL CORPORATION | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 260620 | ||||||||
| Address2: | |||||||||
| City: | ENCINO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 914360620 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8187085285 | ||||||||
| FaxNumber: | 8187085491 | ||||||||
| Practice Location | |||||||||
| Address1: | 18321 CLARK STREET | ||||||||
| Address2: | |||||||||
| City: | TARZANA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 913563501 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8187085285 | ||||||||
| FaxNumber: | 8187085491 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/04/2006 | ||||||||
| LastUpdateDate: | 10/03/2008 | ||||||||
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| AuthorizedOfficialLastName: | KOE | ||||||||
| AuthorizedOfficialFirstName: | NELSON | ||||||||
| AuthorizedOfficialMiddleName: | E | ||||||||
| AuthorizedOfficialTitleorPosition: | PRES OWNER | ||||||||
| AuthorizedOfficialTelephone: | 8187085285 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | G75682 | CA | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Anesthesiology |
No ID Information.