MEDICARE: JEAN CASSANDRA BLAS AGUILAR PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant

General Provider Information

NPI Number	:	1174265730
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEAN CASSANDRA BLAS AGUILAR PA-C

Provider Business Mailing Address
First Line	:	10024 EUBANK LN
Second Line	:
City	:	SPRING VALLEY
State	:	CA
Zip	:	91977-6503
Country	:	US
Telephone Number	:	951-465-0416
Fax Number	:

Provider Business Practice Location Address
First Line	:	10024 EUBANK LN
Second Line	:
City	:	SPRING VALLEY
State	:	CA
Zip	:	91977-6503
Country	:	US
Telephone Number	:	951-465-0416
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/12/2022
Last Update Date	:	04/12/2022

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Directions to “ JEAN CASSANDRA BLAS AGUILAR PA-C” Practice Location

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