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General NPI Number Information
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NPI Number | 1336614239
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Entity Type | Individual
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Provider Name | MIKAELA JAIDE HIPOLITO
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Gender | Female
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Dates
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Enumeration Date | 10/06/2018
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Last Update Date | 12/11/2025
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Provider Practice Location Address
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Address Line | 631 RIVER OAKS PKWY
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City | SAN JOSE
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State | CA
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Zip | 95134-1907
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Country | US
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Telephone | 408-914-7478
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Fax |
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Provider Business Mailing Address
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Address Line | 3485 GAMAY CT
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City | SAN JOSE
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State | CA
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Zip | 95148-1303
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Country | US
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Telephone | 406-386-7190
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106E00000X
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Taxonomy Name | Assistant Behavior Analyst
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License Number |
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License Number State | CA
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