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NPI Code Detail

MEDICARE: JOSE G NIETO M.D.

MEDICARE: JOSE G NIETO M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1174400000XSpecialistME57329FL
2207RN0300XNephrology PhysicianMR57329FL
3207RN0300XNephrology Physician57329FL

General Provider Information

NPI Number : 1811950132
Entity Type Code : Individual
Provider Name (Legal Business Name) : JOSE G NIETO M.D.
Provider Business Mailing Address
First Line : 16501 NW 2ND AVE
Second Line :
City : MIAMI
State : FL
Zip : 33169-6005
Country : US
Telephone Number : 305-354-4558
Fax Number :
Provider Business Practice Location Address
First Line : 16501 NW 2ND AVE
Second Line :
City : MIAMI
State : FL
Zip : 33169-6005
Country : US
Telephone Number : 305-354-4558
Fax Number : 305-354-3884
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/08/2006
Last Update Date : 03/21/2019

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