Healthcare Provider Details

I. General information

NPI: 1023904455
Provider Name (Legal Business Name): JENNIFER AGUILAR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/13/2025
Last Update Date: 05/14/2026
Certification Date: 05/14/2026
Deactivation Date: 07/28/2025
Reactivation Date: 09/08/2025

III. Provider practice location address

495 E ORANGE AVE
EL CENTRO CA
92243-2744
US

IV. Provider business mailing address

202 N 8TH EL CENTRO CA, 92243
EL CENTRO CA
92243
US

V. Phone/Fax

Practice location:
  • Phone: 760-353-6151
  • Fax:
Mailing address:
  • Phone: 442-265-1525
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code373H00000X
TaxonomyDay Training/Habilitation Specialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: