Provider Demographics
NPI:1992134688
Name:NELSON, STANLEY F (MD)
Entity type:Individual
Prefix:
First Name:STANLEY
Middle Name:F
Last Name:NELSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:695 CHARLES E YOUNG DR S
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90095-7088
Mailing Address - Country:US
Mailing Address - Phone:310-991-2635
Mailing Address - Fax:310-794-5446
Practice Address - Street 1:10833 LE CONTE AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90095-3075
Practice Address - Country:US
Practice Address - Phone:310-206-6581
Practice Address - Fax:310-794-5446
Is Sole Proprietor?:No
Enumeration Date:2013-11-04
Last Update Date:2023-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG65639208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics