Individual
ELIJAH RAUL NIETO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
BFA
Contact information
Practice address
255 38TH AVE STE F-I, SAINT CHARLES, IL 60174-5411
(630) 509-8700
Mailing address
255 38TH AVE STE F-I, SAINT CHARLES, IL 60174-5411
(630) 509-8700
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
RBT-24-353576
IL
Other
Enumeration date
06/20/2024
Last updated
06/20/2024
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