Provider Demographics
NPI:1548262959
Name:PRIETO, INMA C (MD)
Entity type:Individual
Prefix:
First Name:INMA
Middle Name:C
Last Name:PRIETO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3801 HAUCK RD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45241-1609
Mailing Address - Country:US
Mailing Address - Phone:513-671-1702
Mailing Address - Fax:513-671-7639
Practice Address - Street 1:3801 HAUCK RD
Practice Address - Street 2:SUITE 1
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45241-1609
Practice Address - Country:US
Practice Address - Phone:513-671-1702
Practice Address - Fax:513-671-7639
Is Sole Proprietor?:No
Enumeration Date:2005-08-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH35059544P207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0787671Medicaid
OH0787671Medicaid
E65526Medicare UPIN