Provider Demographics
NPI:1639055718
Name:GASTON, MILES
Entity type:Individual
Prefix:
First Name:MILES
Middle Name:
Last Name:GASTON
Suffix:
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 1:1624 BROCKTON WAY
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94578-2138
Mailing Address - Country:US
Mailing Address - Phone:510-294-9525
Mailing Address - Fax:
Practice Address - Street 1:1624 BROCKTON WAY
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:CA
Practice Address - Zip Code:94578-2138
Practice Address - Country:US
Practice Address - Phone:510-294-9525
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-13
Last Update Date:2025-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician