Basic Information
| Provider Information | |||||||||
| NPI: | 1902065279 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | NELSON | ||||||||
| FirstName: | CARLA | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | FILE 73679 BOX 60000 | ||||||||
| Address2: | |||||||||
| City: | SAN FRANISCO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 941600000 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7074641989 | ||||||||
| FaxNumber: | 7074649593 | ||||||||
| Practice Location | |||||||||
| Address1: | 780 E WASHINGTON BLVD | ||||||||
| Address2: | STE 202 | ||||||||
| City: | CRESCENT CITY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 955318397 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7074646715 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/03/2008 | ||||||||
| LastUpdateDate: | 01/12/2010 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | A101230 | CA | Y | Allopathic & Osteopathic Physicians | Pediatrics |
No ID Information.