Provider Demographics
NPI:1174265730
Name:AGUILAR, JEAN CASSANDRA BLAS (PA-C)
Entity Type:Individual
Prefix:
First Name:JEAN CASSANDRA
Middle Name:BLAS
Last Name:AGUILAR
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10024 EUBANK LN
Mailing Address - Street 2:
Mailing Address - City:SPRING VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:91977-6503
Mailing Address - Country:US
Mailing Address - Phone:951-465-0416
Mailing Address - Fax:
Practice Address - Street 1:10024 EUBANK LN
Practice Address - Street 2:
Practice Address - City:SPRING VALLEY
Practice Address - State:CA
Practice Address - Zip Code:91977-6503
Practice Address - Country:US
Practice Address - Phone:951-465-0416
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-12
Last Update Date:2022-04-12
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant