Healthcare Provider Details

I. General information

NPI: 1821918764
Provider Name (Legal Business Name): FELIPE AGUAYO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2026
Last Update Date: 07/20/2026
Certification Date: 07/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

85 RAMONA EXPY
PERRIS CA
92571-7014
US

IV. Provider business mailing address

23375 GERBERA ST
MORENO VALLEY CA
92553-9663
US

V. Phone/Fax

Practice location:
  • Phone: 951-349-4195
  • Fax:
Mailing address:
  • Phone: 951-630-0404
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberY6702827
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: