Provider Demographics
NPI:1902065279
Name:NELSON, CARLA (MD)
Entity Type:Individual
Prefix:DR
First Name:CARLA
Middle Name:
Last Name:NELSON
Suffix:
Gender:F
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:FILE 73679 BOX 60000
Mailing Address - Street 2:
Mailing Address - City:SAN FRANISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94160-0000
Mailing Address - Country:US
Mailing Address - Phone:707-464-1989
Mailing Address - Fax:707-464-9593
Practice Address - Street 1:780 E WASHINGTON BLVD
Practice Address - Street 2:STE 202
Practice Address - City:CRESCENT CITY
Practice Address - State:CA
Practice Address - Zip Code:95531-8397
Practice Address - Country:US
Practice Address - Phone:707-464-6715
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-03
Last Update Date:2010-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA101230208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics