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NPI Code Detail

MEDICARE: NILES AQUE SAN PEDRO

MEDICARE: NILES AQUE SAN PEDRO
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1106S00000XBehavior Technician

General Provider Information

NPI Number : 1184556086
Entity Type Code : Individual
Provider Name (Legal Business Name) : NILES AQUE SAN PEDRO
Provider Business Mailing Address
First Line : 1797 ORCHARD AVE
Second Line :
City : SAN LEANDRO
State : CA
Zip : 94577-2621
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 4900 HOPYARD RD STE 100
Second Line :
City : PLEASANTON
State : CA
Zip : 94588-7101
Country : US
Telephone Number : 424-522-8391
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/02/2026
Last Update Date : 06/02/2026

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Directions to “ NILES AQUE SAN PEDRO ” Practice Location

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