Healthcare Provider Details

I. General information

NPI: 1245581529
Provider Name (Legal Business Name): KAREN JOHANNA AGUILAR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/26/2012
Last Update Date: 08/11/2022
Certification Date: 08/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5417 ZELZAH AVE APT 207
ENCINO CA
91316-2275
US

IV. Provider business mailing address

5417 ZELZAH AVE APT 207
ENCINO CA
91316-2275
US

V. Phone/Fax

Practice location:
  • Phone: 818-912-0431
  • Fax:
Mailing address:
  • Phone: 818-912-0431
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW109324
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: