Healthcare Provider Details

I. General information

NPI: 1548907041
Provider Name (Legal Business Name): BERTHA AGUILAR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2022
Last Update Date: 08/10/2022
Certification Date: 08/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8142 SUNLAND BLVD
SUN VALLEY CA
91352
US

IV. Provider business mailing address

8142 SUNLAND BLVD
SUN VALLEY CA
91352
US

V. Phone/Fax

Practice location:
  • Phone: 818-582-8848
  • Fax: 818-582-8836
Mailing address:
  • Phone: 818-582-8848
  • Fax: 323-866-1881

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: