Healthcare Provider Details

I. General information

NPI: 1467382002
Provider Name (Legal Business Name): RAQUEL VICTORIA AGUILERA ALVARADO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/22/2026
Last Update Date: 05/22/2026
Certification Date: 05/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1708 WOODMILL ST
CHESAPEAKE VA
23320-0639
US

IV. Provider business mailing address

6740 PERRY PENNEY DR
ANNANDALE VA
22003-3562
US

V. Phone/Fax

Practice location:
  • Phone: 630-965-0103
  • Fax:
Mailing address:
  • Phone: 202-751-7439
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number0739000042
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: