Healthcare Provider Details

I. General information

NPI: 1326902693
Provider Name (Legal Business Name): JENNIFER AGUILAR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/11/2025
Last Update Date: 12/11/2025
Certification Date: 12/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2160 NE WILLIAMSON CT
BEND OR
97701-3760
US

IV. Provider business mailing address

2160 NE WILLIAMSON CT
BEND OR
97701-3760
US

V. Phone/Fax

Practice location:
  • Phone: 541-389-1118
  • Fax: 541-389-2099
Mailing address:
  • Phone: 541-389-1118
  • Fax: 541-389-2099

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number115532
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: