Provider Demographics
NPI:1104649417
Name:AGUINALDO, MARIE ANGELI
Entity type:Individual
Prefix:
First Name:MARIE ANGELI
Middle Name:
Last Name:AGUINALDO
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1102 E CLARK AVE STE 120A
Mailing Address - Street 2:
Mailing Address - City:SANTA MARIA
Mailing Address - State:CA
Mailing Address - Zip Code:93455-5175
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1102 E CLARK AVE STE 120A
Practice Address - Street 2:
Practice Address - City:SANTA MARIA
Practice Address - State:CA
Practice Address - Zip Code:93455-5175
Practice Address - Country:US
Practice Address - Phone:805-332-8185
Practice Address - Fax:805-332-8186
Is Sole Proprietor?:No
Enumeration Date:2024-11-05
Last Update Date:2025-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95032363363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner