Provider Demographics
NPI:1952545642
Name:PRIETO, RITO JESUS (IDMT)
Entity type:Individual
Prefix:MR
First Name:RITO
Middle Name:JESUS
Last Name:PRIETO
Suffix:
Gender:M
Credentials:IDMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3458 NEELY RD.
Mailing Address - Street 2:
Mailing Address - City:MAFB
Mailing Address - State:NJ
Mailing Address - Zip Code:08641
Mailing Address - Country:US
Mailing Address - Phone:609-754-9033
Mailing Address - Fax:609-754-9015
Practice Address - Street 1:3458 NEELY RD.
Practice Address - Street 2:
Practice Address - City:MAFB
Practice Address - State:NJ
Practice Address - Zip Code:08641
Practice Address - Country:US
Practice Address - Phone:609-754-9033
Practice Address - Fax:609-754-9015
Is Sole Proprietor?:No
Enumeration Date:2009-04-24
Last Update Date:2009-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1003XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Medical Technicians