Provider Demographics
NPI:1093415648
Name:AGUILERA, MARIA PATRICIA (MA BCBA)
Entity Type:Individual
Prefix:MRS
First Name:MARIA
Middle Name:PATRICIA
Last Name:AGUILERA
Suffix:
Gender:F
Credentials:MA BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10453 NATIONS CIR
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95209-4550
Mailing Address - Country:US
Mailing Address - Phone:209-607-3481
Mailing Address - Fax:
Practice Address - Street 1:10453 NATIONS CIR
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95209-4550
Practice Address - Country:US
Practice Address - Phone:209-607-3481
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-02
Last Update Date:2023-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1-21-55624103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty