Healthcare Provider Details

I. General information

NPI: 1972440303
Provider Name (Legal Business Name): NICOLAS ERROL OBERES-PADRE
Entity Type: Individual
Gender:
Sole Proprietor: Y

Provider Other Name: NICO OBERES-PADRE

II. Dates (important events)

Enumeration Date: 05/04/2026
Last Update Date: 05/04/2026
Certification Date: 05/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

826 INDIAN AVE
SAN MATEO CA
94401-1723
US

IV. Provider business mailing address

826 INDIAN AVE
SAN MATEO CA
94401-1723
US

V. Phone/Fax

Practice location:
  • Phone: 650-350-0806
  • Fax:
Mailing address:
  • Phone: 650-350-0806
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: