Basic Information
| Provider Information | |||||||||
| NPI: | 1962986109 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | AGUILAR | ||||||||
| FirstName: | ALEJANDRA | ||||||||
| MiddleName: | JUAREZ | ||||||||
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| Mailing Information | |||||||||
| Address1: | 11731 TELEGRAPH RD STE K | ||||||||
| Address2: | |||||||||
| City: | SANTA FE SPRINGS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 906706815 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6267014344 | ||||||||
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| Practice Location | |||||||||
| Address1: | 11741 TELEGRAPH RD | ||||||||
| Address2: | |||||||||
| City: | SANTA FE SPRINGS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 906703681 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3232425000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/24/2018 | ||||||||
| LastUpdateDate: | 10/07/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/07/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 101YM0800X | ASW103425 | CA | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.