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NPI Code Detail

MEDICARE: HEATHER AGUALO

MEDICARE: HEATHER AGUALO
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
1101YA0400XAddiction (Substance Use Disorder) Counselor
2101YM0800XMental Health Counselor

General Provider Information

NPI Number : 1518208743
Entity Type Code : Individual
Provider Name (Legal Business Name) : HEATHER AGUALO
Provider Business Mailing Address
First Line : 1605 JEFFERSON ST
Second Line :
City : OAKLAND
State : CA
Zip : 94612-1215
Country : US
Telephone Number : 510-923-1099
Fax Number : 510-350-8793
Provider Business Practice Location Address
First Line : 1605 JEFFERSON ST
Second Line :
City : OAKLAND
State : CA
Zip : 94612-1215
Country : US
Telephone Number : 510-923-1099
Fax Number : 510-350-8793
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/13/2013
Last Update Date : 06/12/2023

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Directions to “ HEATHER AGUALO ” Practice Location

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