Provider Demographics
NPI:1033071519
Name:NIETO, PATRICIA G
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:G
Last Name:NIETO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1197 TURQUOISE ST
Mailing Address - Street 2:
Mailing Address - City:CALEXICO
Mailing Address - State:CA
Mailing Address - Zip Code:92231-4045
Mailing Address - Country:US
Mailing Address - Phone:760-352-5712
Mailing Address - Fax:760-337-3139
Practice Address - Street 1:1256 BROADWAY AVE # 7
Practice Address - Street 2:
Practice Address - City:EL CENTRO
Practice Address - State:CA
Practice Address - Zip Code:92243-2317
Practice Address - Country:US
Practice Address - Phone:760-352-5712
Practice Address - Fax:760-337-3139
Is Sole Proprietor?:No
Enumeration Date:2025-12-02
Last Update Date:2025-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN168150164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse