MEDICARE: DR. JEANNIE MARIE AGUILAR PH.D., BCBA-D

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	103K00000X	Behavior Analyst	1-07-3729

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1-07-3729	OTHER		BEHAVIOR ANALYST CERTIFICATION BOARD

General Provider Information

NPI Number	:	1669620845
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JEANNIE MARIE AGUILAR PH.D., BCBA-D

Provider Business Mailing Address
First Line	:	2338 W ROYAL PALM RD STE J
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85021-9339
Country	:	US
Telephone Number	:	855-772-8847
Fax Number	:

Provider Business Practice Location Address
First Line	:	2338 W ROYAL PALM RD STE J
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85021-9339
Country	:	US
Telephone Number	:	855-772-8847
Fax Number	:

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

Provider Enumeration Date	:	08/31/2008
Last Update Date	:	11/07/2024

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