Healthcare Provider Details

I. General information

NPI: 1588070445
Provider Name (Legal Business Name): MICHELLE LEE AGUILERA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/10/2014
Last Update Date: 09/05/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6396 MCLEOD DR STE 9
LAS VEGAS NV
89120-4429
US

IV. Provider business mailing address

8455 W SAHARA AVE APT 202
LAS VEGAS NV
89117-1842
US

V. Phone/Fax

Practice location:
  • Phone: 702-912-0600
  • Fax:
Mailing address:
  • Phone: 702-542-2655
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: