Healthcare Provider Details

I. General information

NPI: 1366707705
Provider Name (Legal Business Name): ANGEL R. AGUILAR MSW, ASW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/11/2012
Last Update Date: 05/07/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 EMPIRE ST
FAIRFIELD CA
94533-5702
US

IV. Provider business mailing address

801 EMPIRE ST
FAIRFIELD CA
94533-5702
US

V. Phone/Fax

Practice location:
  • Phone: 707-425-5744
  • Fax:
Mailing address:
  • Phone: 707-425-5744
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number33872
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: