Healthcare Provider Details

I. General information

NPI: 1457718876
Provider Name (Legal Business Name): AUSTIN AGUILAR
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/16/2016
Last Update Date: 01/16/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1720 TERMINO AVE
LONG BEACH CA
90804-2104
US

IV. Provider business mailing address

10550 BOLSA AVE APT 5
GARDEN GROVE CA
92843-5232
US

V. Phone/Fax

Practice location:
  • Phone: 562-494-0585
  • Fax:
Mailing address:
  • Phone: 714-554-9923
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License Number810374
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: