Healthcare Provider Details

I. General information

NPI: 1184150955
Provider Name (Legal Business Name): MRS. STEPHANIE A AGUAYO GALLO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/11/2017
Last Update Date: 09/18/2026
Certification Date: 09/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5115 VIA CORONA ST
LOS ANGELES CA
90022-2006
US

IV. Provider business mailing address

5115 VIA CORONA ST
LOS ANGELES CA
90022-2006
US

V. Phone/Fax

Practice location:
  • Phone: 323-266-4371
  • Fax:
Mailing address:
  • Phone: 909-933-3882
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: