Individual
EIDA NIETO
Active
Sole proprietor
Provider details
NPI number
Gender
F
Credential
FMD
Contact information
Practice address
4469 NW 167TH ST, OPA LOCKA, FL 33055-4311
(305) 621-1455
(305) 621-5508
Mailing address
11031 NE 6TH AVE, MIAMI, FL 33161-7182
(305) 398-6100
(305) 757-4465
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
Other
Enumeration date
06/14/2006
Last updated
07/08/2007
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