Healthcare Provider Details

I. General information

NPI: 1104733518
Provider Name (Legal Business Name): JACQUELYN VICTORIA AGUILAR JIMENEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2026
Last Update Date: 08/24/2026
Certification Date: 08/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

619 3RD ST
ORLAND CA
95963-1340
US

IV. Provider business mailing address

242 N VILLA AVE
WILLOWS CA
95988-2641
US

V. Phone/Fax

Practice location:
  • Phone: 530-865-1622
  • Fax:
Mailing address:
  • Phone: 530-934-6582
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: