MEDICARE: DAISY CORINA 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
1	207R00000X	Internal Medicine Physician	54734	MN
2	207RC0000X	Cardiovascular Disease Physician	Q1693	TX

General Provider Information

NPI Number	:	1881826121
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAISY CORINA NIETO M.D.

Provider Business Mailing Address
First Line	:	4301 N MESA ST STE 100
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79902-1118
Country	:	US
Telephone Number	:	915-532-6767
Fax Number	:	915-532-4023

Provider Business Practice Location Address
First Line	:	4301 N MESA ST STE 100
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79902-1118
Country	:	US
Telephone Number	:	915-532-6767
Fax Number	:	915-532-4023

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/20/2009
Last Update Date	:	05/10/2016

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