Healthcare Provider Details

I. General information

NPI: 1346901774
Provider Name (Legal Business Name): JENNIFER AGUILAR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/07/2022
Last Update Date: 09/28/2022
Certification Date: 09/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

222 E MAIN ST STE 117
BARSTOW CA
92311-2365
US

IV. Provider business mailing address

1801 RIMROCK RD APT H23
BARSTOW CA
92311-5780
US

V. Phone/Fax

Practice location:
  • Phone: 760-255-1496
  • Fax:
Mailing address:
  • Phone: 760-261-8776
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: