Provider Demographics
NPI:1124232186
Name:AGUILERA, MIGUEL (PPS SCHOOL PSYCHOLOG)
Entity Type:Individual
Prefix:
First Name:MIGUEL
Middle Name:
Last Name:AGUILERA
Suffix:
Gender:M
Credentials:PPS SCHOOL PSYCHOLOG
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:265 CALLE DE LA ALIANZA
Mailing Address - Street 2:
Mailing Address - City:SAN YSIDRO
Mailing Address - State:CA
Mailing Address - Zip Code:92173-2110
Mailing Address - Country:US
Mailing Address - Phone:619-662-1591
Mailing Address - Fax:
Practice Address - Street 1:265 CALLE DE LA ALIANZA
Practice Address - Street 2:
Practice Address - City:SAN YSIDRO
Practice Address - State:CA
Practice Address - Zip Code:92173-2110
Practice Address - Country:US
Practice Address - Phone:619-662-1591
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAU6029238103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool