Healthcare Provider Details

I. General information

NPI: 1831556919
Provider Name (Legal Business Name): JENNIFER NICOLE AGUILAR RN, NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JENNIFER NICOLE MEDINA

II. Dates (important events)

Enumeration Date: 01/21/2016
Last Update Date: 01/21/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14124 FOOTHILL BLVD SUITE 100
SYLMAR CA
91342-8049
US

IV. Provider business mailing address

14722 SUNDANCE PL
CANYON COUNTRY CA
91387-1563
US

V. Phone/Fax

Practice location:
  • Phone: 818-367-1012
  • Fax:
Mailing address:
  • Phone: 661-733-1649
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number775714
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License Number78974
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95003670
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: