Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2080N0001X | Neonatal-Perinatal Doctor | E4567 | TX |
N | 2080P0203X | Pediatric Critical Care Doctor | E4567 | TX |
NPI | 1013047919 |
---|---|
Provider Name | Dr. Carlos Nieto JR. |
First Address | Odessa, TX 79763-4206 |
Second Address | Odessa, TX 79763-4206 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/03/2007 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
8896J2 | BCBS (01) | TX |
C19908 | (02) |