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General NPI Number Information
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NPI Number | 1205343944
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Entity Type | Individual
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Provider Name | THERESA RAE AGUILAR MD, MPH
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Gender | Female
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Dates
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Enumeration Date | 01/03/2018
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Last Update Date | 02/18/2025
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Provider Practice Location Address
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Address Line | 1179 N MCDOWELL BLVD
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City | PETALUMA
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State | CA
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Zip | 94954-6559
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Country | US
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Telephone | 707-559-7500
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Fax |
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Provider Business Mailing Address
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Address Line | 1179 N MCDOWELL BLVD
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City | PETALUMA
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State | CA
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Zip | 94954-6559
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Country | US
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Telephone | 707-559-7500
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 289482
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License Number State | MA
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | A196655
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License Number State | CA
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