Individual
JULIA NIETO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1315 W SOUTHERN AVE, TEMPE, AZ 85282
(602) 569-3999
(602) 569-3887
Mailing address
1533 E WILLETTA ST, PHOENIX, AZ 85006-2935
(602) 569-3999
(602) 569-3887
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
6451
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
194468
—
AZ
Enumeration date
09/16/2016
Last updated
08/23/2019
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