=====================================================
General NPI Number Information
=====================================================
NPI Number | 1588486203
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DENISE Y AGUILUZ
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/25/2024
-----------------------------------------------------
Last Update Date | 10/25/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 22750 HAWTHORNE BLVD STE 229
-----------------------------------------------------
City | TORRANCE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90505-3670
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 828-998-4521
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1026 S BONNIE BEACH PL
-----------------------------------------------------
City | LOS ANGELES
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90023-2535
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 323-819-7476
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number | 17086
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------