Healthcare Provider Details

I. General information

NPI: 1790331908
Provider Name (Legal Business Name): ALLISON CHRISTINE AGUILAR RN, PHN, CSN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MS. ALLISON CHRISTINE MOORE

II. Dates (important events)

Enumeration Date: 08/13/2019
Last Update Date: 08/13/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1777 S 11TH ST
LOS BANOS CA
93635-4800
US

IV. Provider business mailing address

1777 S 11TH ST
LOS BANOS CA
93635-4800
US

V. Phone/Fax

Practice location:
  • Phone: 209-827-0120
  • Fax: 209-827-3552
Mailing address:
  • Phone: 209-827-0120
  • Fax: 209-827-3552

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License Number69749
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License Number656007
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: