Reuben Randall Nelson

Primary specialty

Addiction (Substance Use Disorder) Registered NurseTaxonomy code 163WA0400X

License

369324 Issued in CA

Practice address

11482 Loma Linda Dr
Loma Linda, CA 92354-3743

Phone

(909) 723-7877

NPI assigned

Feb 29, 2024

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• G & C Swan Inc

  • Substance Abuse Rehabilitation Facility
  • Ontario, CA
  • NPI 1497132765
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1709164800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1709164800000",
    "number": "1073370656",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3286 E GUASTI RD STE 100",
            "city": "ONTARIO",
            "state": "CA",
            "postal_code": "917618646",
            "telephone_number": "909-476-2023"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11482 LOMA LINDA DR",
            "city": "LOMA LINDA",
            "state": "CA",
            "postal_code": "923543743",
            "telephone_number": "909-723-7877"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NELSON",
        "first_name": "REUBEN",
        "middle_name": "RANDALL",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2024-02-29",
        "last_updated": "2024-02-29",
        "certification_date": "2024-02-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WA0400X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Addiction (Substance Use Disorder)",
            "state": "CA",
            "license": "369324",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Allen Nedley, MD
• Antoine Jean Nehme
• Andrew Neiheisel, M.D.
• Nathan Jack Nellessen
• Mekenzie Nelson
• Ryan Andrew Nelson, MD, MPH, DIPABPM
• Scott C Nelson, M.D.
• Alexander Michael Nemirov, DO
• Mia Nepomuceno-Perez, M.D.
• Karin Zabel Nercissian

• Addiction (Substance Use Disorder) Registered Nurse in Loma Linda, CA
• Providers in Loma Linda, CA by specialty
• Addiction (Substance Use Disorder) Registered Nurse in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 29, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.