Provider Demographics
NPI:1871729665
Name:NIETO, MARIA (MD)
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:
Last Name:NIETO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 SE OSCEOLA ST
Mailing Address - Street 2:STE 200A
Mailing Address - City:STUART
Mailing Address - State:FL
Mailing Address - Zip Code:34994-2503
Mailing Address - Country:US
Mailing Address - Phone:561-318-0252
Mailing Address - Fax:561-744-0735
Practice Address - Street 1:401 SE OSCEOLA ST
Practice Address - Street 2:STE 200A
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34994-2503
Practice Address - Country:US
Practice Address - Phone:561-318-0252
Practice Address - Fax:561-744-0735
Is Sole Proprietor?:No
Enumeration Date:2009-06-08
Last Update Date:2021-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA241605207V00000X
FLME128094207VF0040X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VF0040XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyUrogynecology and Reconstructive Pelvic Surgery
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL017290600Medicaid
FLIP274ZMedicare PIN