Provider Demographics
NPI:1154725109
Name:NIETO, RUBEN JAMES (BCBA)
Entity type:Individual
Prefix:
First Name:RUBEN
Middle Name:JAMES
Last Name:NIETO
Suffix:
Gender:M
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 836
Mailing Address - Street 2:
Mailing Address - City:MERCEDES
Mailing Address - State:TX
Mailing Address - Zip Code:78570-0836
Mailing Address - Country:US
Mailing Address - Phone:956-246-5839
Mailing Address - Fax:
Practice Address - Street 1:305 N 1ST ST
Practice Address - Street 2:
Practice Address - City:DONNA
Practice Address - State:TX
Practice Address - Zip Code:78537-2320
Practice Address - Country:US
Practice Address - Phone:956-246-5839
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-20
Last Update Date:2014-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1-12-11474103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst