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General NPI Number Information
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NPI Number | 1063662377
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Entity Type | Individual
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Provider Name | BERENICE ALEJANDRINA NIETO IBCLC
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Gender | Female
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Dates
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Enumeration Date | 09/23/2008
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Last Update Date | 09/23/2008
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Provider Practice Location Address
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Address Line | 1000 SAN LEANDRO BLVD
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City | SAN LEANDRO
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State | CA
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Zip | 94577-1598
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Country | US
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Telephone | 510-618-3735
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Fax | 510-667-3139
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Provider Business Mailing Address
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Address Line | 1302 PACIFIC AVE
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City | SAN LEANDRO
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State | CA
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Zip | 94577-2517
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Country | US
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Telephone | 510-506-1135
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Fax | 510-667-3139
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 172V00000X
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Taxonomy Name | Community Health Worker
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 105-22276
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License Number State | CA
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