Healthcare Provider Details

I. General information

NPI: 1902732829
Provider Name (Legal Business Name): MERLY DANCEL AGUDA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/18/2026
Last Update Date: 06/18/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9845 ALTA MESA RD
WILTON CA
95693-9643
US

IV. Provider business mailing address

PO BOX 409
WILTON CA
95693-0409
US

V. Phone/Fax

Practice location:
  • Phone: 916-821-2176
  • Fax:
Mailing address:
  • Phone: 916-821-2176
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number340318075
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: