Healthcare Provider Details

I. General information

NPI: 1194390708
Provider Name (Legal Business Name): ERIKA AGUILAR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/25/2021
Last Update Date: 05/25/2021
Certification Date: 05/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 SAN GABRIEL BLVD STE 200
ROSEMEAD CA
91770-4394
US

IV. Provider business mailing address

6151 KINGMAN AVE APT E
BUENA PARK CA
90621-2377
US

V. Phone/Fax

Practice location:
  • Phone: 323-724-0019
  • Fax: 323-724-3539
Mailing address:
  • Phone: 714-391-4305
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code126800000X
TaxonomyDental Assistant
License Number90655
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: