Healthcare Provider Details

I. General information

NPI: 1174859656
Provider Name (Legal Business Name): KENIA GABRIELA AGUILAR ASW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KENIA RIVAS

II. Dates (important events)

Enumeration Date: 10/19/2009
Last Update Date: 03/13/2026
Certification Date: 03/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17800 HWY 18
APPLE VALLEY CA
92307
US

IV. Provider business mailing address

17800 US HIGHWAY 18
APPLE VALLEY CA
92307-1221
US

V. Phone/Fax

Practice location:
  • Phone: 760-946-8200
  • Fax:
Mailing address:
  • Phone: 760-946-8200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number137507
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: