ROBERTO M NIETO (NPI# 1750430419) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1750430419 |
| Entity Type | Individual |
| Full Name | ROBERTO M NIETO |
| Credential | M.D. |
| Practice Address |
2800 E Broad St Suite 504 Mansfield TX 76063-6409 |
| Practice Telephone | 8172250410 |
| Practice Fax Number | 8174198561 |
| Mailing Telephone | 8172250410 |
| Mailing Fax Number | 8174198561 |
| Enumeration Date | 2007-01-10 |
| Last Update Date | 2019-03-20 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2084N0400X |
Psychiatry & Neurology Specialization: Neurology |
J2967 | TX | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| TX | 119215502 | 05 | |
| TX | BLUE CROSS BLUE SHIELD | 89M402 | 01 |
| TX | 083092901 | 05 | |
| TX | RAILROAD MEDICARE | 130011976 | 01 |
| Street Address |
2800 E BROAD ST SUITE 504 |
| City | MANSFIELD |
| State | TX |
| Zip Code | 76063-6409 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1942287388 | John Tiu | Internal Medicine | 2800 E Broad St, Suite 514, Mansfield, TX 76063-6417 | 2005-12-28 |
| 1740736099 | Kyla Crispe | Physician Assistant | 2800 E Broad St, Ste #124, Mansfield, TX 76063-6414 | 2016-08-28 |
| 1902264732 | Paige Herlihy | Physician Assistant | 2800 E Broad St, Suite 124, Mansfield, TX 76063-6409 | 2016-02-08 |
| 1215392840 | Center for Scoliosis and Advanced Spine Surgery | Orthopaedic Surgery | 2800 E Broad St, 512, Mansfield, TX 76063-6409 | 2015-12-26 |
| 1669857595 | Uyen Ngoc Bao Phan | Physician Assistant | 2800 E Broad St, Suite 124, Mansfield, TX 76063-6409 | 2015-07-21 |
| 1982945127 | Hospitalist Partners of Excellence In Mansfield (h.o.p.e), P.a. | Clinic/Center | 2800 E Broad St, Suite 308, Mansfield, TX 76063-6412 | 2013-03-13 |
| 1902160708 | Helen Kaporis | Dermatology | 2800 E Broad St, Ste 124, Mansfield, TX 76063-6409 | 2012-06-27 |
| 1164793246 | Amy Renee Lewis | Nurse Practitioner | 2800 E Broad St, Suite 504, Mansfield, TX 76063-6409 | 2012-01-20 |
| 1144541202 | Magdala Poon | Psychiatry & Neurology | 2800 E Broad St, Suite 504, Mansfield, TX 76063-6409 | 2010-06-11 |
| 1598913253 | Mansfield Dermatology, Pllc | Dermatology | 2800 E Broad St, Suite 408, Mansfield, TX 76063-6414 | 2008-09-05 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1316558349 | Lindsey Vandyke, D.o. Pllc | Internal Medicine | 3150 E Broad Street, Ste 100, Mansfield, TX 76063 | 2020-08-13 |
| 1942819867 | Jennifer Que Chau Nguyen | Pharmacist | 980 U.S. 287 Frontage Rd #287, Mansfield, TX 76063 | 2020-07-27 |
| 1194346890 | Ana Maria Gonzalez | Dentist | 1600 Us Highway 287, Suite 102, Mansfield, TX 76063 | 2020-05-04 |
| 1245869080 | Stateserv Medical of Texas, LLC | Durable Medical Equipment & Medical Supplies | 7941 Rodeo Trail, Mansfield, TX 76063 | 2020-04-03 |
| 1649802232 | Mary Puanani Kamai | Nurse Practitioner | 1301 E. Debbie Lane, Suite 102 #1405, Mansfield, TX 76063 | 2020-02-11 |
| 1770123028 | Gladys Vera Nfodzo | Nurse Practitioner | 901 W. Broad St, Mansfield, TX 76063 | 2020-01-14 |
| 1669011300 | Alexa Smith | Nurse Practitioner | 2800 E Broad St #304, Mansfield, TX 76063 | 2019-12-28 |
| 1477190437 | Mel Rockwall LLC | Optometrist | 1701 East Broad Street, Ste 109, Mansfield, TX 76063 | 2019-12-09 |
| 1376185512 | Daniel Max & Marcandrea LLC | Optometrist | 1701 East Broad St., Ste 109, Mansfield, TX 76063 | 2019-10-09 |
| 1861046385 | Lacey Eaton | Counselor | 805 Killian Dr, Mansfield, TX 76063 | 2019-08-01 |
| Find all providers in zip 76063 | ||||
| Taxonomy Code | 2084N0400X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Psychiatry & Neurology |
| Specialization | Neurology |
| A Neurologist specializes in the diagnosis and treatment of diseases or impaired function of the brain, spinal cord, peripheral nerves, muscles, autonomic nervous system, and blood vessels that relate to these structures. |
| Notes: Source: The American Board of Psychiatry and Neurology, Inc. www.abpn.com [1/1/2007: new definition] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1881725075 | Donna Ellen Newsome | Psychiatry & Neurology | 900 N Walnut Creek Dr, Ste. 100#211, Mansfield, TX 76063-8046 | 2007-03-08 |
| 1225132277 | Donna Ellen Newsome | Psychiatry & Neurology | 2364 N. Hwy 287, Suite 119, Mansfield, TX 76063 | 2006-09-12 |
| 1598752701 | Mansfield Neurology Inc | Psychiatry & Neurology | 222 Marion Ave, Mansfield, OH 44903-2138 | 2005-10-03 |
| 1114367786 | Suraj Rajan | Psychiatry & Neurology | 335 Glessner Ave, Mansfield, OH 44903-2269 | 2013-06-27 |
| 1144541202 | Magdala Poon | Psychiatry & Neurology | 2800 E Broad St, Suite 504, Mansfield, TX 76063-6409 | 2010-06-11 |
| 1043338312 | Neurology Associates of Arlington, P.a. | Psychiatry & Neurology | 2800 E Broad St, Suite 504, Mansfield, TX 76063-6409 | 2007-03-26 |
| 1619010535 | Central Ohio Neurology Inc | Psychiatry & Neurology | 370 Cline Avenue, Ste C5, Mansfield, OH 44907-1057 | 2007-02-14 |
| 1205985934 | Robert E Mcmichael | Psychiatry & Neurology | 2800 E Broad St, Suite 504, Mansfield, TX 76063-6409 | 2007-01-10 |
| 1891844577 | Ganana Tesfa | Psychiatry & Neurology | 2800 E Broad St, Suite 504, Mansfield, TX 76063 | 2007-01-10 |
| 1508875634 | Raymond Joseph Baddour | Psychiatry & Neurology | 370 Cline Ave, Ste C5, Mansfield, OH 44907-1057 | 2006-08-07 |
| Find all providers in MANSFIELD | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.