Healthcare Provider Details

I. General information

NPI: 1518857374
Provider Name (Legal Business Name): MIRA OCTA AGUILAR NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/03/2025
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

114 PACIFICA STE 150
IRVINE CA
92618-3326
US

IV. Provider business mailing address

114 PACIFICA STE 150
IRVINE CA
92618-3326
US

V. Phone/Fax

Practice location:
  • Phone: 949-257-2644
  • Fax:
Mailing address:
  • Phone: 949-257-2644
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95035749
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: