Healthcare Provider Details

I. General information

NPI: 1295661593
Provider Name (Legal Business Name): LEIA NICOLE AGUILAR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2026
Last Update Date: 06/23/2026
Certification Date: 06/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21250 BOX SPRINGS RD STE 201
MORENO VALLEY CA
92557-8712
US

IV. Provider business mailing address

6185 MAGNOLIA AVE # 224
RIVERSIDE CA
92506-2524
US

V. Phone/Fax

Practice location:
  • Phone: 951-335-5858
  • Fax: 951-335-5870
Mailing address:
  • Phone: 951-335-5858
  • Fax: 951-335-5870

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number135215
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: