Individual provider Active NPI

Christine Alicia Nelson

  • Family Nurse Practitioner
  • Upland, CA
National Provider Identifier
1720733942
Registry record updated Feb 16, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
95018675 Issued in CA
Practice address
1060 E Foothill Blvd Ste 103
Upland, CA 91786-4070
Phone
(909) 981-8904
NPI assigned
Feb 16, 2022
Last updated
Feb 16, 2022By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 16, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 95018675 CA Primary

Addresses

Primary practice location

1060 E Foothill Blvd Ste 103
Upland, CA 91786-4070

Mailing address

14619 Decoy LN
Fontana, CA 92336-0413
Phone (909) 743-1809

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20221111000693 CA Practitioner - Nurse Practitioner 7214304815 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
95018675CAMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Hedyeh M Golshan MD and Associates Inc CurrentSince Aug 22, 2022 Accepting new patients
Ghassan Hadi MD Inc PastSince Feb 24, 2022 Accepting new patients

Locations

1850 N Riverside Ave
Ste 230
Rialto, CA 92376
Phone (909) 821-0810

Organizations & group practices 2

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

NPI Registry JSON

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

{
    "created_epoch": "1644969600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1644969600000",
    "number": "1720733942",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14619 DECOY LN",
            "city": "FONTANA",
            "state": "CA",
            "postal_code": "923360413",
            "telephone_number": "909-743-1809"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1060 E FOOTHILL BLVD STE 103",
            "city": "UPLAND",
            "state": "CA",
            "postal_code": "917864070",
            "telephone_number": "909-981-8904"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NELSON",
        "first_name": "CHRISTINE",
        "middle_name": "ALICIA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-02-16",
        "last_updated": "2022-02-16",
        "certification_date": "2022-01-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "CA",
            "license": "95018675",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Upland, CA

Sources for this page

Verify at the official NPI Registry.