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General NPI Number Information
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NPI Number | 1437370301
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Entity Type | Organization
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Legal Business Name | STEPHANIE NIETO
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Dates
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Enumeration Date | 05/01/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 2031 E MAIN ST
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City | UVALDE
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State | TX
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Zip | 78801-4851
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Country | US
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Telephone | 830-591-1359
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Fax | 830-591-1362
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Provider Business Mailing Address
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Address Line | 2031 E MAIN ST
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City | UVALDE
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State | TX
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Zip | 78801-4851
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Country | US
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Telephone | 830-591-1359
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Fax | 830-591-1362
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Authorized Official
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Title or Position | OWNER
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Name | STEPHANIE NIETO
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Credential | RN
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Telephone | 830-591-1359
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA0600X
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Taxonomy Name | Adult Day Care Clinic/Center
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License Number | 120271
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License Number State | TX
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