Healthcare Provider Details

I. General information

NPI: 1255576534
Provider Name (Legal Business Name): AARON RENEE GILLEN DMFT, AMFT, CMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: AARON RENEE HAGER HHP/MASSAGE THERAPI

II. Dates (important events)

Enumeration Date: 12/15/2008
Last Update Date: 09/16/2024
Certification Date: 09/16/2024
Deactivation Date: 05/17/2022
Reactivation Date: 09/16/2024

III. Provider practice location address

721 N VULCAN AVE STE 211&213
ENCINITAS CA
92024-2190
US

IV. Provider business mailing address

23809 SCARLET OAK DR
MURRIETA CA
92562
US

V. Phone/Fax

Practice location:
  • Phone: 760-638-2595
  • Fax:
Mailing address:
  • Phone: 760-638-2595
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code405300000X
TaxonomyPrevention Professional
License NumberAMFT144579
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberAMFT144579
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License NumberAMFT144579
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code172M00000X
TaxonomyMechanotherapist
License NumberMA60055729
License Number StateWA
# 5
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberCMT91063
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: