Healthcare Provider Details

I. General information

NPI: 1477143915
Provider Name (Legal Business Name): EILEEN JANE AGUILA HA7079
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/19/2021
Last Update Date: 01/19/2021
Certification Date: 01/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4015 GOVERNOR DR
SAN DIEGO CA
92122-2522
US

IV. Provider business mailing address

4015 GOVERNOR DR
SAN DIEGO CA
92122-2522
US

V. Phone/Fax

Practice location:
  • Phone: 858-458-9019
  • Fax: 858-458-9268
Mailing address:
  • Phone: 858-458-9019
  • Fax: 858-458-9268

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License NumberHA7079
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: