Provider Demographics
NPI:1427062215
Name:NIETO, RALPH (RT RADIOLOGIC TECH)
Entity type:Individual
Prefix:MR
First Name:RALPH
Middle Name:
Last Name:NIETO
Suffix:
Gender:M
Credentials:RT RADIOLOGIC TECH
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 532844
Mailing Address - Street 2:
Mailing Address - City:HARLINGEN
Mailing Address - State:TX
Mailing Address - Zip Code:78553
Mailing Address - Country:US
Mailing Address - Phone:956-440-9729
Mailing Address - Fax:956-440-8882
Practice Address - Street 1:17745 US EXPRESSWAY 83
Practice Address - Street 2:
Practice Address - City:HARLINGEN
Practice Address - State:TX
Practice Address - Zip Code:78552
Practice Address - Country:US
Practice Address - Phone:956-440-9729
Practice Address - Fax:956-440-8882
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXR23048293D00000X, 335V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered293D00000XLaboratoriesPhysiological Laboratory
Not Answered335V00000XSuppliersPortable X-ray and/or Other Portable Diagnostic Imaging Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
FTXU13OtherIDTF
459877Medicare ID - Type Unspecified