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General NPI Number Information
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NPI Number | 1619469293
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Entity Type | Organization
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Legal Business Name | SANDRA NIETO, MD, A MEDICAL CORPORATION
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Dates
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Enumeration Date | 05/31/2018
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Last Update Date | 05/31/2018
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Provider Practice Location Address
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Address Line | 433 N 4TH ST STE 211
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City | MONTEBELLO
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State | CA
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Zip | 90640-4309
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Country | US
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Telephone | 323-786-8833
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Fax | 323-967-6067
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Provider Business Mailing Address
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Address Line | PO BOX 2559
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City | MONTEBELLO
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State | CA
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Zip | 90640-7359
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Country | US
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Telephone | 323-786-8833
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Fax | 323-967-6067
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Authorized Official
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Title or Position | PRESIDENT
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Name | SANDRA NIETO
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Credential | MD
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Telephone | 323-786-8833
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number |
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License Number State |
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