Jackson Robert Carlson Ade
Individual provider Active NPI Behavior Technician · Hayward, CA
NPI 1760200752 · NPPES record last updated Sep 30, 2024
Key facts
- NPI
- 1760200752
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Behavior Technician 106S00000X
- Practice address
- 20900 Corsair Blvd
Hayward, CA 94545-1002 - Phone
- (855) 223-7123
- Fax
- (619) 374-7134
- NPI assigned
- Sep 30, 2024
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Behavior Technician | 106S00000X | Yes |
Addresses
Primary practice location
20900 Corsair Blvd
Hayward, CA 94545-1002
Mailing address
PO Box 33568
San Diego, CA 92163-3568
Phone (855) 223-7123
Other providers in Hayward, CA
- Active Life Physical Therapy, Inc.
- Alejandra Acu Morales
- Edith Acuna
- April Nicole Adams
- Gina Adayo
- Iyabo Adediran
- Kehinde Adeshina
- Theresa Annette Adeyemi
- Sandra Nicole Adina
- Demani Levay Adkins
All providers in Hayward, CA · Behavior Technician in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 30, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.