Provider Demographics
NPI:1073204541
Name:ARAGON, SELENE ESBAYDE
Entity Type:Individual
Prefix:
First Name:SELENE
Middle Name:ESBAYDE
Last Name:ARAGON
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 1:11838 MOUNT CAMBRIDGE CT
Mailing Address - Street 2:
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91737-7917
Mailing Address - Country:US
Mailing Address - Phone:909-401-4315
Mailing Address - Fax:
Practice Address - Street 1:12740 HESPERIA RD STE B
Practice Address - Street 2:
Practice Address - City:VICTORVILLE
Practice Address - State:CA
Practice Address - Zip Code:92395-8306
Practice Address - Country:US
Practice Address - Phone:760-999-0918
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-16
Last Update Date:2023-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95204226363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily