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General NPI Number Information
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NPI Number | 1790119931
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Entity Type | Individual
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Provider Name | JACQUELINE ADELA AGUILAR
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Gender | Female
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Dates
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Enumeration Date | 08/23/2013
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Last Update Date | 04/06/2022
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Provider Practice Location Address
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Address Line | 2447 PACIFIC COAST HWY FL 2
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City | HERMOSA BEACH
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State | CA
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Zip | 90254-2743
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Country | US
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Telephone | 951-333-4627
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Fax |
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Provider Business Mailing Address
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Address Line | 1201 N CATALINA AVE UNIT 4083
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City | REDONDO BEACH
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State | CA
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Zip | 90277-8308
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Country | US
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Telephone | 951-333-4627
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | LCSW98686
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License Number State | CA
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