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NPI Code Detail

MEDICARE: JACQUELINE ADELA AGUILAR

MEDICARE: JACQUELINE ADELA AGUILAR
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
11041C0700XClinical Social WorkerLCSW98686CA

General Provider Information

NPI Number : 1790119931
Entity Type Code : Individual
Provider Name (Legal Business Name) : JACQUELINE ADELA AGUILAR
Provider Business Mailing Address
First Line : 1201 N CATALINA AVE UNIT 4083
Second Line :
City : REDONDO BEACH
State : CA
Zip : 90277-8308
Country : US
Telephone Number : 951-333-4627
Fax Number :
Provider Business Practice Location Address
First Line : 2447 PACIFIC COAST HWY FL 2
Second Line :
City : HERMOSA BEACH
State : CA
Zip : 90254-2743
Country : US
Telephone Number : 951-333-4627
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/23/2013
Last Update Date : 04/06/2022

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Directions to “ JACQUELINE ADELA AGUILAR ” Practice Location

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