Provider Demographics
NPI:1427766963
Name:AGUILAR, KATIE H
Entity type:Individual
Prefix:
First Name:KATIE
Middle Name:H
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 1:2240 LAKE WASHINGTON BLVD STE 130
Mailing Address - Street 2:
Mailing Address - City:WEST SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95691-6424
Mailing Address - Country:US
Mailing Address - Phone:916-617-2331
Mailing Address - Fax:
Practice Address - Street 1:2240 LAKE WASHINGTON BLVD STE 130
Practice Address - Street 2:
Practice Address - City:WEST SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95691-6424
Practice Address - Country:US
Practice Address - Phone:916-617-2331
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-14
Last Update Date:2022-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP95022662363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner