Healthcare Provider Details

I. General information

NPI: 1790278463
Provider Name (Legal Business Name): FRANCISCO JAVIER AGUILAR PIZANO LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: JAVIER AGUILAR LCSW

II. Dates (important events)

Enumeration Date: 06/07/2018
Last Update Date: 05/17/2022
Certification Date: 05/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1504 3RD ST N
NAMPA ID
83687
US

IV. Provider business mailing address

PO BOX 9
NAMPA ID
83653-0009
US

V. Phone/Fax

Practice location:
  • Phone: 208-345-1170
  • Fax: 208-345-3502
Mailing address:
  • Phone: 208-461-7149
  • Fax: 208-467-3391

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW-41489
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: