Healthcare Provider Details

I. General information

NPI: 1649680810
Provider Name (Legal Business Name): MAY AGUILAR
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/28/2014
Last Update Date: 04/28/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22992 SERRA DR
CARSON CA
90745-4966
US

IV. Provider business mailing address

22992 SERRA DR
CARSON CA
90745-4966
US

V. Phone/Fax

Practice location:
  • Phone: 424-558-2582
  • Fax:
Mailing address:
  • Phone: 424-558-2582
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License Number9500567
License Number StateCA

VIII. Authorized Official

Name: FELICIA PONDER
Title or Position: OFFICE ADMINISTRATOR
Credential:
Phone: 951-315-1265