Provider Demographics
NPI:1093013823
Name:NIETO, JUDITH
Entity type:Individual
Prefix:MS
First Name:JUDITH
Middle Name:
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 1:12310 LOWER AZUSA ROAD
Mailing Address - Street 2:
Mailing Address - City:ARCADIA
Mailing Address - State:CA
Mailing Address - Zip Code:91006-5872
Mailing Address - Country:US
Mailing Address - Phone:626-579-8593
Mailing Address - Fax:626-433-1029
Practice Address - Street 1:12310 LOWER AZUSA ROAD
Practice Address - Street 2:
Practice Address - City:ARCADIA
Practice Address - State:CA
Practice Address - Zip Code:91006-5872
Practice Address - Country:US
Practice Address - Phone:626-579-8593
Practice Address - Fax:626-433-1029
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-02
Last Update Date:2011-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator