Active NPI
Raymond Nieblas
- Home Modifications Contractor
- Rancho Cucamonga, CA
National Provider Identifier
1336890748
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Home Modifications Contractor
- License
- 1027249
- Practice address
- 13213 Miller Ave
Rancho Cucamonga, CA 91739-9657 - Phone
- (626) 374-3904
- NPI assigned
- Jan 17, 2022
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Home Modifications Contractor | 171WH0202X | 1027249 | CA | Primary |
Addresses
Primary practice location
13213 Miller Ave
Rancho Cucamonga, CA 91739-9657
Mailing address
13213 Miller Ave
Rancho Cucamonga, CA 91739-9657
Phone (626) 374-3904
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1027249 | CA | MD | Home Modifications Contractor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1642377600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1642377600000",
"number": "1336890748",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "13213 MILLER AVE",
"city": "RANCHO CUCAMONGA",
"state": "CA",
"postal_code": "917399657",
"telephone_number": "626-374-3904"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "13213 MILLER AVE",
"city": "RANCHO CUCAMONGA",
"state": "CA",
"postal_code": "917399657",
"telephone_number": "626-374-3904"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NIEBLAS",
"first_name": "RAYMOND",
"name_prefix": "Mr.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2022-01-17",
"last_updated": "2022-01-17",
"certification_date": "2022-01-17",
"status": "A"
},
"taxonomies": [
{
"code": "171WH0202X",
"taxonomy_group": "",
"desc": "Contractor, Home Modifications",
"state": "CA",
"license": "1027249",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Rancho Cucamonga, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 17, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.