Provider Demographics
NPI:1306661392
Name:AGUILAR, JUAN ANGEL
Entity type:Individual
Prefix:
First Name:JUAN
Middle Name:ANGEL
Last Name:AGUILAR
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1474 E SUCCESS DR
Mailing Address - Street 2:
Mailing Address - City:PORTERVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:93257-5624
Mailing Address - Country:US
Mailing Address - Phone:559-756-2695
Mailing Address - Fax:
Practice Address - Street 1:140 S C ST
Practice Address - Street 2:
Practice Address - City:PORTERVILLE
Practice Address - State:CA
Practice Address - Zip Code:93257-4822
Practice Address - Country:US
Practice Address - Phone:559-521-0632
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-15
Last Update Date:2024-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator