Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207QG0300X | Family Doctor - Geriatric Medicine | P1469 | TX |
Y | 207QH0002X | Family Doctor - Hospice and Palliative Medicine | P1469 | TX |
NPI | 1609097294 |
---|---|
Provider Name | Janet Lieto |
First Address | Fort Worth, TX 76199-0335 |
Second Address | Fort Worth, TX 76107-2553 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/05/2007 |
Last Update Date | 13/07/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
284763401 | (05) | TX |
6401805 | (05) | NJ |
8CY268 | BCBS (01) | TX |
F98296 | (02) | NJ |
P00998011 | RAILROAD MEDICARE (01) | TX |