Healthcare Provider Details

I. General information

NPI: 1861805509
Provider Name (Legal Business Name): MELANIE DAPHNE AGUILAR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/10/2014
Last Update Date: 05/14/2025
Certification Date: 05/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

43520 DIVISION ST
LANCASTER CA
93535-4089
US

IV. Provider business mailing address

43520 DIVISION ST
LANCASTER CA
93535-4089
US

V. Phone/Fax

Practice location:
  • Phone: 661-266-4758
  • Fax: 661-266-1210
Mailing address:
  • Phone: 661-266-4758
  • Fax: 661-266-1210

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code373H00000X
TaxonomyDay Training/Habilitation Specialist
License Number
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: