Basic Information
| Provider Information | |||||||||
| NPI: | 1891881017 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | AGUILERA | ||||||||
| FirstName: | DANIEL | ||||||||
| MiddleName: | HENRY | ||||||||
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| Credential: | MSW PHD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4028 E FLORENCE AVE | ||||||||
| Address2: | |||||||||
| City: | BELL | ||||||||
| State: | CA | ||||||||
| PostalCode: | 902013404 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2132012786 | ||||||||
| FaxNumber: | 2139897701 | ||||||||
| Practice Location | |||||||||
| Address1: | 123 S ALVARADO STREET | ||||||||
| Address2: | |||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900572201 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2139897700 | ||||||||
| FaxNumber: | 2139897702 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/05/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | LCS6644 | CA | Y | Behavioral Health & Social Service Providers | Social Worker |
No ID Information.