Healthcare Provider Details

I. General information

NPI: 1437370301
Provider Name (Legal Business Name): STEPHANIE NIETO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/01/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2031 E MAIN ST
UVALDE TX
78801-4851
US

IV. Provider business mailing address

2031 E MAIN ST
UVALDE TX
78801-4851
US

V. Phone/Fax

Practice location:
  • Phone: 830-591-1359
  • Fax: 830-591-1362
Mailing address:
  • Phone: 830-591-1359
  • Fax: 830-591-1362

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number120271
License Number StateTX

VIII. Authorized Official

Name: STEPHANIE NIETO
Title or Position: OWNER
Credential: RN
Phone: 830-591-1359