Healthcare Provider Details

I. General information

NPI: 1023946795
Provider Name (Legal Business Name): STACY YOUNG NA AGUILAR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: STACY YOUNG NA

II. Dates (important events)

Enumeration Date: 05/12/2026
Last Update Date: 05/12/2026
Certification Date: 05/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

408 JUNIPERO SERRA DR
SAN GABRIEL CA
91776-1235
US

IV. Provider business mailing address

4653 LOWELL AVE
LA CRESCENTA CA
91214-1600
US

V. Phone/Fax

Practice location:
  • Phone: 626-451-5400
  • Fax:
Mailing address:
  • Phone: 818-439-6630
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: