Provider Demographics
NPI:1972197879
Name:NIETO JIMENEZ, PAOLA ANDREA
Entity Type:Individual
Prefix:
First Name:PAOLA
Middle Name:ANDREA
Last Name:NIETO JIMENEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:268 BANTRY DR
Mailing Address - Street 2:
Mailing Address - City:VACAVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95688-8566
Mailing Address - Country:US
Mailing Address - Phone:707-592-0703
Mailing Address - Fax:
Practice Address - Street 1:268 BANTRY DR
Practice Address - Street 2:
Practice Address - City:VACAVILLE
Practice Address - State:CA
Practice Address - Zip Code:95688-8566
Practice Address - Country:US
Practice Address - Phone:707-592-0703
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-22
Last Update Date:2021-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program