Provider Demographics
NPI:1952191371
Name:PRIETO MEDICAL PRACTICE
Entity type:Organization
Organization Name:PRIETO MEDICAL PRACTICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:HELENA
Authorized Official - Middle Name:
Authorized Official - Last Name:PRIETO
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:510-292-1957
Mailing Address - Street 1:1638 CODDINGTON RD
Mailing Address - Street 2:
Mailing Address - City:BROOKTONDALE
Mailing Address - State:NY
Mailing Address - Zip Code:14817-9542
Mailing Address - Country:US
Mailing Address - Phone:510-292-1957
Mailing Address - Fax:510-292-1957
Practice Address - Street 1:1638 CODDINGTON RD
Practice Address - Street 2:
Practice Address - City:BROOKTONDALE
Practice Address - State:NY
Practice Address - Zip Code:14817-9542
Practice Address - Country:US
Practice Address - Phone:510-292-1957
Practice Address - Fax:510-292-1957
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-05-08
Last Update Date:2025-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)