Healthcare Provider Details

I. General information

NPI: 1376468306
Provider Name (Legal Business Name): NIDIA ADELINA PEREZ PABLO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2026
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13847 E 14TH ST STE 214A
SAN LEANDRO CA
94578-2626
US

IV. Provider business mailing address

1501 23RD AVE APT 3
OAKLAND CA
94606-5034
US

V. Phone/Fax

Practice location:
  • Phone: 510-225-4040
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberAMFT164432
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: