Basic Information
| Provider Information | |||||||||
| NPI: | 1013163989 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | AGUILAR | ||||||||
| FirstName: | MIGUEL | ||||||||
| MiddleName: | ANGEL | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | MS. AMFT 1118711 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2440 TULARE ST STE 200 | ||||||||
| Address2: | |||||||||
| City: | FRESNO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 937212281 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5592845852 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 121 BELMONT AVE | ||||||||
| Address2: | |||||||||
| City: | MENDOTA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 936408232 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5594434800 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/12/2008 | ||||||||
| LastUpdateDate: | 03/01/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/01/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101Y00000X | N | Behavioral Health & Social Service Providers | Counselor | 106H00000X | CA | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.