Provider Demographics
NPI:1801991583
Name:J.F. NIETO, M.D., P.A.
Entity type:Organization
Organization Name:J.F. NIETO, M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:J. FELIPE
Authorized Official - Middle Name:
Authorized Official - Last Name:NIETO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:713-641-5656
Mailing Address - Street 1:3208 BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77017-2321
Mailing Address - Country:US
Mailing Address - Phone:713-641-5656
Mailing Address - Fax:713-641-5293
Practice Address - Street 1:3208 BROADWAY ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77017-2321
Practice Address - Country:US
Practice Address - Phone:713-641-5656
Practice Address - Fax:713-641-5293
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-14
Last Update Date:2010-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF7365261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX133829502Medicaid
TX000000CA82OtherBC BS
TX133829507Medicaid
TX133829507Medicaid
TX=========004OtherTRICARE SOUTH REGION
D67025Medicare UPIN