Provider Demographics
NPI:1740342492
Name:NIETO, ANDRES A (MD)
Entity type:Individual
Prefix:DR
First Name:ANDRES
Middle Name:A
Last Name:NIETO
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1 CALIFORNIA ST STE 2300
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94111-5424
Mailing Address - Country:US
Mailing Address - Phone:800-997-6196
Mailing Address - Fax:415-504-1367
Practice Address - Street 1:1 CALIFORNIA ST STE 2300
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94111-5424
Practice Address - Country:US
Practice Address - Phone:800-997-6196
Practice Address - Fax:415-504-1367
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-15
Last Update Date:2023-12-20
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLME130371207R00000X
MA269158207R00000X
DEC1-0011949207R00000X
NJ25MA10054800207R00000X
MDD82114207R00000X
RIMD15546207R00000X
IN01077411A207R00000X
NY285948207R00000X
PAMD459148207R00000X
MI4301111101207R00000X
CT55884207R00000X
VT042.0013646207R00000X
MEMD21235207R00000X
VA0101242364207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1740342492OtherNPI