Provider Demographics
NPI:1003830258
Name:NIETO, SANDRA (MD)
Entity Type:Individual
Prefix:DR
First Name:SANDRA
Middle Name:
Last Name:NIETO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8531 VIA SIERRA RAMAL AVE
Mailing Address - Street 2:
Mailing Address - City:WHITTIER
Mailing Address - State:CA
Mailing Address - Zip Code:90605-1246
Mailing Address - Country:US
Mailing Address - Phone:323-786-8833
Mailing Address - Fax:323-967-6067
Practice Address - Street 1:433 N 4TH ST STE 211
Practice Address - Street 2:
Practice Address - City:MONTEBELLO
Practice Address - State:CA
Practice Address - Zip Code:90640-4309
Practice Address - Country:US
Practice Address - Phone:323-786-8333
Practice Address - Fax:323-967-6067
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2022-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA84185207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAAR026AOtherMEDICARE PTAN
CA1003830258OtherNPI
CAAR026AOtherMEDICARE PTAN
CAI45474Medicare UPIN