Healthcare Provider Details

I. General information

NPI: 1053288423
Provider Name (Legal Business Name): BRENDA NIETO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/21/2025
Last Update Date: 10/21/2025
Certification Date: 10/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

335 E AVENUE I
LANCASTER CA
93535-1916
US

IV. Provider business mailing address

335 E AVENUE I
LANCASTER CA
93535-1916
US

V. Phone/Fax

Practice location:
  • Phone: 661-471-4000
  • Fax: 661-471-4000
Mailing address:
  • Phone: 661-471-4000
  • Fax: 661-471-4000

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP2201X
TaxonomyAmbulatory Care Registered Nurse
License Number95107424
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: