Provider Demographics
NPI:1215607668
Name:AGUILAR, ANISSA MONIQUE
Entity type:Individual
Prefix:
First Name:ANISSA
Middle Name:MONIQUE
Last Name:AGUILAR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16275 MIDWAY ST
Mailing Address - Street 2:
Mailing Address - City:VICTORVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:92395-4111
Mailing Address - Country:US
Mailing Address - Phone:909-846-1672
Mailing Address - Fax:
Practice Address - Street 1:391 JENKS DR
Practice Address - Street 2:
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92878-5018
Practice Address - Country:US
Practice Address - Phone:949-922-5988
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-16
Last Update Date:2021-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician