Provider Demographics
NPI:1447739834
Name:NIETO, JOHN PAUL (PA)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:PAUL
Last Name:NIETO
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3303 ROGERS RD STE 130
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78251-3688
Mailing Address - Country:US
Mailing Address - Phone:210-520-2224
Mailing Address - Fax:210-520-2238
Practice Address - Street 1:3303 ROGERS RD STE 130
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78251-3688
Practice Address - Country:US
Practice Address - Phone:210-520-2224
Practice Address - Fax:210-520-2238
Is Sole Proprietor?:No
Enumeration Date:2018-08-07
Last Update Date:2021-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA12192363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXPA12192OtherSTATE LICENSE