Healthcare Provider Details

I. General information

NPI: 1235092024
Provider Name (Legal Business Name): NICOLE MERIZAN-AGUAYO ASCWS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/08/2025
Last Update Date: 12/08/2025
Certification Date: 12/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6625 LA PALMA AVE
BUENA PARK CA
90620-2859
US

IV. Provider business mailing address

6625 LA PALMA AVE
BUENA PARK CA
90620-2859
US

V. Phone/Fax

Practice location:
  • Phone: 714-228-3280
  • Fax:
Mailing address:
  • Phone: 714-228-3280
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number100676
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: