Provider Demographics
NPI:1730702630
Name:NELSON, RYAN ANDREW (MD, MPH, DIPABPM)
Entity type:Individual
Prefix:
First Name:RYAN
Middle Name:ANDREW
Last Name:NELSON
Suffix:
Gender:M
Credentials:MD, MPH, DIPABPM
Other - Prefix:
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Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:2140 MENTONE BLVD SPC 84
Mailing Address - Street 2:
Mailing Address - City:MENTONE
Mailing Address - State:CA
Mailing Address - Zip Code:92359-9688
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:11201 BENTON ST
Practice Address - Street 2:
Practice Address - City:LOMA LINDA
Practice Address - State:CA
Practice Address - Zip Code:92357-2800
Practice Address - Country:US
Practice Address - Phone:909-825-7084
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-26
Last Update Date:2024-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA1874242083P0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive Medicine