Provider Demographics
NPI:1518261049
Name:MARIAELENA NIETO
Entity Type:Organization
Organization Name:MARIAELENA NIETO
Other - Org Name:DINUBA MEDICAL SUPPLY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARIAELENA
Authorized Official - Middle Name:
Authorized Official - Last Name:NIETO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:559-595-0580
Mailing Address - Street 1:301 E TULARE ST
Mailing Address - Street 2:
Mailing Address - City:DINUBA
Mailing Address - State:CA
Mailing Address - Zip Code:93618-2308
Mailing Address - Country:US
Mailing Address - Phone:559-595-0580
Mailing Address - Fax:559-595-0583
Practice Address - Street 1:301 E TULARE ST
Practice Address - Street 2:
Practice Address - City:DINUBA
Practice Address - State:CA
Practice Address - Zip Code:93618-2308
Practice Address - Country:US
Practice Address - Phone:559-595-0580
Practice Address - Fax:559-595-0583
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-23
Last Update Date:2011-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA101692997332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA6581080001Medicare NSC