Mrs.Graciela Teresa Nieto

Primary specialty

Portable X-ray and/or Other Portable Diagnostic Imaging SupplierTaxonomy code 335V00000X

License

R29718 Issued in TX

Legal business name

MRS.GRACIELA TERESA NIETO

Practice address

1405 E Lyon St
Laredo, TX 78040-2733

Phone

(956) 722-9729

Fax

(956) 722-9990

NPI assigned

Apr 15, 2008

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mrs. Graciela Teresa Nieto

Title

Owner

Phone

(956) 535-2818

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Medical X-Ray on Wheels Doing business as

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Portable X-ray supplier certification: CCN 45X0009904

Legal name

MEDICAL X-RAY ON WHEELS

Certification status

Active

Provider type (POS)

Portable X-ray supplier

Participating since

Jun 20, 2006

Last certification

Feb 23, 2016

Ownership / control type

Individual

Facility address

1405 East Lyon
Laredo, TX 78040

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1208217600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1486944000000",
    "number": "1972777548",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1886",
            "city": "HARLINGEN",
            "state": "TX",
            "postal_code": "785511886",
            "telephone_number": "956-722-9729",
            "fax_number": "956-722-9990"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1405 E LYON ST",
            "city": "LAREDO",
            "state": "TX",
            "postal_code": "780402733",
            "telephone_number": "956-722-9729",
            "fax_number": "956-722-9990"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MRS.GRACIELA TERESA NIETO",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-04-15",
        "last_updated": "2017-02-13",
        "status": "A",
        "authorized_official_last_name": "NIETO",
        "authorized_official_first_name": "GRACIELA",
        "authorized_official_middle_name": "TERESA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "956-535-2818",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "335V00000X",
            "taxonomy_group": "",
            "desc": "Portable X-ray and/or Other Portable Diagnostic Imaging Supplier",
            "state": "TX",
            "license": "R29718",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "185111501",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Medical X-Ray on Wheels",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Esmeralda Munoz, LVN

• Portable X-ray and/or Other Portable Diagnostic Imaging Supplier in Laredo, TX
• Providers in Laredo, TX by specialty
• Portable X-ray and/or Other Portable Diagnostic Imaging Supplier in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 13, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.