Healthcare Provider Details

I. General information

NPI: 1629459441
Provider Name (Legal Business Name): MARCIA AGUILAR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARCIA KAILIAN

II. Dates (important events)

Enumeration Date: 06/17/2015
Last Update Date: 03/07/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1038 POST ST
SAN FRANCISCO CA
94109-5603
US

IV. Provider business mailing address

209 PLYMOUTH AVE
SAN FRANCISCO CA
94112-3042
US

V. Phone/Fax

Practice location:
  • Phone: 415-775-2636
  • Fax:
Mailing address:
  • Phone: 209-777-2333
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: