Healthcare Provider Details

I. General information

NPI: 1205243599
Provider Name (Legal Business Name): CARLOS AGUILERA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/17/2014
Last Update Date: 08/06/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

516 VILLA AVE STE 28
CLOVIS CA
93612-7604
US

IV. Provider business mailing address

516 VILLA AVE STE 28
CLOVIS CA
93612-7604
US

V. Phone/Fax

Practice location:
  • Phone: 559-326-0730
  • Fax:
Mailing address:
  • Phone: 559-326-0730
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number58346
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: