Basic Information
| Provider Information | |||||||||
| NPI: | 1831475136 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | NELKIN | ||||||||
| FirstName: | CORY | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 285 N EL CAMINO STE. 117-118 | ||||||||
| Address2: | |||||||||
| City: | ENCINITAS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 920245383 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8773814115 | ||||||||
| FaxNumber: | 8589011461 | ||||||||
| Practice Location | |||||||||
| Address1: | 15615 POMERADO RD | ||||||||
| Address2: | |||||||||
| City: | POWAY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 920642405 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8586134000 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/31/2011 | ||||||||
| LastUpdateDate: | 09/16/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 09/16/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | P8058 | TX | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | L0103652-0328 | TX | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | 20A13311 | CA | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.