Healthcare Provider Details

I. General information

NPI: 1336287598
Provider Name (Legal Business Name): KIMBERLY AGUINAGA L.B.S.W.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/01/2007
Last Update Date: 10/09/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

43740 N GROESBECK HWY
CLINTON TOWNSHIP MI
48036-1139
US

IV. Provider business mailing address

43740 N GROESBECK HWY
CLINTON TOWNSHIP MI
48036-1139
US

V. Phone/Fax

Practice location:
  • Phone: 586-469-7629
  • Fax:
Mailing address:
  • Phone: 586-469-7629
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number6801063890
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: