1144439746 NPI number — FRANK NIETO MSW

Table of content: FRANK NIETO MSW (NPI 1144439746)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1144439746 NPI number — FRANK NIETO MSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
NIETO
Provider First Name:
FRANK
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MSW
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1144439746
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/14/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8813 ROUNDTABLE CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FAIR OAKS
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95628-6430
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
916-967-7255
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3330 HEIGHTS DR
Provider Second Line Business Practice Location Address:
STE 120
Provider Business Practice Location Address City Name:
CAMERON PARK
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95682-7769
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-677-4404
Provider Business Practice Location Address Fax Number:
530-677-4545
Provider Enumeration Date:
05/21/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  LCS6919 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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