Healthcare Provider Details

I. General information

NPI: 1013604339
Provider Name (Legal Business Name): MRS. NINA RAE AGUILA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MS. NINA RAE CERNA

II. Dates (important events)

Enumeration Date: 04/18/2023
Last Update Date: 04/18/2023
Certification Date: 04/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11850 PIERCE ST STE 200
RIVERSIDE CA
92505-5184
US

IV. Provider business mailing address

11850 PIERCE ST STE 200
RIVERSIDE CA
92505-5184
US

V. Phone/Fax

Practice location:
  • Phone: 951-465-3664
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: