Healthcare Provider Details

I. General information

NPI: 1356698807
Provider Name (Legal Business Name): VALERIE R AGUILAR PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/14/2012
Last Update Date: 02/24/2021
Certification Date: 02/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

604 ROSE AVE
VENICE CA
90291-2767
US

IV. Provider business mailing address

305 EAST CENTER AVE.
VISALIA CA
93291-6331
US

V. Phone/Fax

Practice location:
  • Phone: 310-392-8636
  • Fax: 310-392-6642
Mailing address:
  • Phone: 559-737-4700
  • Fax: 559-737-4782

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA22413
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: