Basic Information
Provider Information | |||||||||
NPI: | 1740342492 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | NIETO | ||||||||
FirstName: | ANDRES | ||||||||
MiddleName: | A | ||||||||
NamePrefix: | DR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | M.D. | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 1 CALIFORNIA ST STE 2300 | ||||||||
Address2: |   | ||||||||
City: | SAN FRANCISCO | ||||||||
State: | CA | ||||||||
PostalCode: | 941115424 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8009976196 | ||||||||
FaxNumber: | 4155041367 | ||||||||
Practice Location | |||||||||
Address1: | 1 CALIFORNIA ST STE 2300 | ||||||||
Address2: |   | ||||||||
City: | SAN FRANCISCO | ||||||||
State: | CA | ||||||||
PostalCode: | 941115424 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8009976196 | ||||||||
FaxNumber: | 4155041367 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 12/15/2006 | ||||||||
LastUpdateDate: | 10/13/2022 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | Y | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 10/13/2022 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | ME130371 | FL | N |   | Allopathic & Osteopathic Physicians | Internal Medicine |   | 207R00000X | 269158 | MA | N |   | Allopathic & Osteopathic Physicians | Internal Medicine |   | 207R00000X | C1-0011949 | DE | N |   | Allopathic & Osteopathic Physicians | Internal Medicine |   | 207R00000X | 25MA10054800 | NJ | N |   | Allopathic & Osteopathic Physicians | Internal Medicine |   | 207R00000X | D82114 | MD | N |   | Allopathic & Osteopathic Physicians | Internal Medicine |   | 207R00000X | MD15546 | RI | N |   | Allopathic & Osteopathic Physicians | Internal Medicine |   | 207R00000X | 01077411A | IN | N |   | Allopathic & Osteopathic Physicians | Internal Medicine |   | 207R00000X | 285948 | NY | N |   | Allopathic & Osteopathic Physicians | Internal Medicine |   | 207R00000X | MD459148 | PA | N |   | Allopathic & Osteopathic Physicians | Internal Medicine |   | 207R00000X | 4301111101 | MI | N |   | Allopathic & Osteopathic Physicians | Internal Medicine |   | 207R00000X | 55884 | CT | N |   | Allopathic & Osteopathic Physicians | Internal Medicine |   | 207R00000X | 042.0013646 | VT | N |   | Allopathic & Osteopathic Physicians | Internal Medicine |   | 207R00000X | MD21235 | ME | N |   | Allopathic & Osteopathic Physicians | Internal Medicine |   | 207R00000X | 0101242364 | VA | Y |   | Allopathic & Osteopathic Physicians | Internal Medicine |   |
No ID Information.