Provider Demographics
NPI:1124186614
Name:AGUILAR, DENISE (RN PA NP)
Entity Type:Individual
Prefix:MRS
First Name:DENISE
Middle Name:
Last Name:AGUILAR
Suffix:
Gender:F
Credentials:RN PA NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1377 E HERNDON AVE
Mailing Address - Street 2:SUITE 104
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93720-3022
Mailing Address - Country:US
Mailing Address - Phone:559-450-7455
Mailing Address - Fax:559-450-7473
Practice Address - Street 1:1377 E HERNDON AVE
Practice Address - Street 2:SUITE 104
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93720-3022
Practice Address - Country:US
Practice Address - Phone:559-450-7455
Practice Address - Fax:559-450-7473
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2012-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA15084363A00000X
CA10980363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
S97978Medicare UPIN