Healthcare Provider Details

I. General information

NPI: 1184954414
Provider Name (Legal Business Name): MS. GRACIELA BELEN AGUILAR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/08/2010
Last Update Date: 02/28/2024
Certification Date: 02/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2677 N MAIN ST STE 110
SANTA ANA CA
92705-6663
US

IV. Provider business mailing address

1800 N BRISTOL ST # C-488
SANTA ANA CA
92706-3336
US

V. Phone/Fax

Practice location:
  • Phone: 714-274-7577
  • Fax:
Mailing address:
  • Phone: 714-574-3763
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number128208
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: