Healthcare Provider Details

I. General information

NPI: 1306275029
Provider Name (Legal Business Name): ANGELICA AGUILERA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/04/2013
Last Update Date: 11/04/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2637 W BURREL AVE
VISALIA CA
93291-4511
US

IV. Provider business mailing address

636 E CYPRESS AVE
VISALIA CA
93292-2959
US

V. Phone/Fax

Practice location:
  • Phone: 559-747-0115
  • Fax:
Mailing address:
  • Phone: 559-799-3384
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: