Healthcare Provider Details

I. General information

NPI: 1720283211
Provider Name (Legal Business Name): FABIOLA DEL AGUILA PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2007
Last Update Date: 08/15/2025
Certification Date: 08/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

949 PALM AVE
IMPERIAL BEACH CA
91932
US

IV. Provider business mailing address

949 PALM AVE
IMPERIAL BEACH CA
91932-1503
US

V. Phone/Fax

Practice location:
  • Phone: 619-356-3757
  • Fax:
Mailing address:
  • Phone: 619-429-3733
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number1108
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number3797
License Number StateOR
# 3
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number24471
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: