Provider Demographics
NPI:1346560794
Name:AGUILAR, ROSALVA FUENTES (PA-C)
Entity type:Individual
Prefix:MRS
First Name:ROSALVA
Middle Name:FUENTES
Last Name:AGUILAR
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3605 HOSPITAL RD
Mailing Address - Street 2:
Mailing Address - City:ATWATER
Mailing Address - State:CA
Mailing Address - Zip Code:95301-5173
Mailing Address - Country:US
Mailing Address - Phone:209-381-2000
Mailing Address - Fax:209-357-7263
Practice Address - Street 1:6596 N WINTON WAY STE E
Practice Address - Street 2:
Practice Address - City:WINTON
Practice Address - State:CA
Practice Address - Zip Code:95388-9532
Practice Address - Country:US
Practice Address - Phone:209-357-7755
Practice Address - Fax:209-357-7263
Is Sole Proprietor?:No
Enumeration Date:2010-06-08
Last Update Date:2018-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA20930363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant