Provider Demographics
NPI:1063280550
Name:NIETO, BIANCA (RADT)
Entity type:Individual
Prefix:
First Name:BIANCA
Middle Name:
Last Name:NIETO
Suffix:
Gender:F
Credentials:RADT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:427 PAJARO ST STE 4
Mailing Address - Street 2:
Mailing Address - City:SALINAS
Mailing Address - State:CA
Mailing Address - Zip Code:93901-3459
Mailing Address - Country:US
Mailing Address - Phone:831-424-6655
Mailing Address - Fax:831-424-9717
Practice Address - Street 1:913 BLANCO CIR
Practice Address - Street 2:
Practice Address - City:SALINAS
Practice Address - State:CA
Practice Address - Zip Code:93901-4401
Practice Address - Country:US
Practice Address - Phone:831-424-6655
Practice Address - Fax:831-424-9717
Is Sole Proprietor?:No
Enumeration Date:2023-12-14
Last Update Date:2024-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist