Provider Demographics
NPI:1265701973
Name:NELSON, RONALD MILO (MD)
Entity type:Individual
Prefix:DR
First Name:RONALD
Middle Name:MILO
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 1:79720 NORTHWOOD
Mailing Address - Street 2:
Mailing Address - City:LA QUINTA
Mailing Address - State:CA
Mailing Address - Zip Code:92253-5000
Mailing Address - Country:US
Mailing Address - Phone:760-771-2005
Mailing Address - Fax:760-771-2106
Practice Address - Street 1:79720 NORTHWOOD
Practice Address - Street 2:
Practice Address - City:LA QUINTA
Practice Address - State:CA
Practice Address - Zip Code:92253-5000
Practice Address - Country:US
Practice Address - Phone:760-771-2005
Practice Address - Fax:760-771-2106
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-26
Last Update Date:2011-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAGFE8434261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty