Provider Demographics
NPI:1245581529
Name:AGUILAR, KAREN JOHANNA
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:JOHANNA
Last Name:AGUILAR
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 1:5417 ZELZAH AVE APT 207
Mailing Address - Street 2:
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91316-2275
Mailing Address - Country:US
Mailing Address - Phone:818-912-0431
Mailing Address - Fax:
Practice Address - Street 1:5417 ZELZAH AVE APT 207
Practice Address - Street 2:
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91316-2275
Practice Address - Country:US
Practice Address - Phone:818-912-0431
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-26
Last Update Date:2022-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CALCSW1093241041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program