Healthcare Provider Details

I. General information

NPI: 1114535283
Provider Name (Legal Business Name): MISS ROSARIO JASMINE AGUILAR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/15/2020
Last Update Date: 03/17/2026
Certification Date: 03/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 MCHENRY AVE # 11B
MODESTO CA
95350-4373
US

IV. Provider business mailing address

1701 CALA VITA PL
MANTECA CA
95337-8740
US

V. Phone/Fax

Practice location:
  • Phone: 209-550-5869
  • Fax:
Mailing address:
  • Phone: 209-250-6058
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: