Healthcare Provider Details

I. General information

NPI: 1649034588
Provider Name (Legal Business Name): RUTH NIETO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/12/2024
Last Update Date: 08/11/2025
Certification Date: 08/11/2025
Deactivation Date: 05/08/2025
Reactivation Date: 08/11/2025

III. Provider practice location address

2150 S LEWIS ST APT 111
ANAHEIM CA
92802-5044
US

IV. Provider business mailing address

217 E STANFORD ST
SANTA ANA CA
92707-1828
US

V. Phone/Fax

Practice location:
  • Phone: 714-831-9983
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: