Provider Demographics
NPI:1427423029
Name:NILES, BENJAMIN II
Entity type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:
Last Name:NILES
Suffix:II
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:145 COLUMBIA
Mailing Address - Street 2:SUITE 200
Mailing Address - City:ALISO VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92656-1413
Mailing Address - Country:US
Mailing Address - Phone:949-228-0985
Mailing Address - Fax:
Practice Address - Street 1:145 COLUMBIA
Practice Address - Street 2:SUITE 200
Practice Address - City:ALISO VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92656-1413
Practice Address - Country:US
Practice Address - Phone:949-228-0985
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-12-08
Last Update Date:2015-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)