Healthcare Provider Details

I. General information

NPI: 1225430218
Provider Name (Legal Business Name): JULIE NIETO R.D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/22/2014
Last Update Date: 09/22/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3848 VETERANS MEMORIAL BLVD STE 101
METAIRIE LA
70002
US

IV. Provider business mailing address

3848 VETERANS MEMORIAL BLVD STE 101
METAIRIE LA
70002
US

V. Phone/Fax

Practice location:
  • Phone: 504-885-2505
  • Fax: 504-885-2510
Mailing address:
  • Phone: 504-885-2505
  • Fax: 504-885-2510

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number2573
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: