Provider Demographics
NPI:1427474634
Name:NELSON, JAMIE LYNN (DPT)
Entity type:Individual
Prefix:
First Name:JAMIE
Middle Name:LYNN
Last Name:NELSON
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:JAMIE
Other - Middle Name:LYNN
Other - Last Name:FIAMENGO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:23121 ANTONIO PKWY
Mailing Address - Street 2:SUITE 100
Mailing Address - City:RANCHO SANTA MARGARITA
Mailing Address - State:CA
Mailing Address - Zip Code:92688-2658
Mailing Address - Country:US
Mailing Address - Phone:949-713-6445
Mailing Address - Fax:949-713-6488
Practice Address - Street 1:23121 ANTONIO PKWY
Practice Address - Street 2:SUITE 100
Practice Address - City:RANCHO SANTA MARGARITA
Practice Address - State:CA
Practice Address - Zip Code:92688-2658
Practice Address - Country:US
Practice Address - Phone:949-713-6445
Practice Address - Fax:949-713-6488
Is Sole Proprietor?:No
Enumeration Date:2014-03-12
Last Update Date:2021-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT41055208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation