Healthcare Provider Details

I. General information

NPI: 1457628554
Provider Name (Legal Business Name): ANTONIO AGUILAR JR.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/17/2011
Last Update Date: 09/01/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7485 N PALM AVE STE 103
FRESNO CA
93711-5764
US

IV. Provider business mailing address

925 SIERRA ST
PARLIER CA
93648-9670
US

V. Phone/Fax

Practice location:
  • Phone: 559-221-8100
  • Fax: 559-221-8101
Mailing address:
  • Phone: 559-974-0625
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: