Provider Demographics
NPI:1295023976
Name:AGUILAR, ANA LILLIAN
Entity Type:Individual
Prefix:
First Name:ANA
Middle Name:LILLIAN
Last Name:AGUILAR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ANA
Other - Middle Name:
Other - Last Name:LOPEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:994 S HARRISON RD
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85748
Mailing Address - Country:US
Mailing Address - Phone:520-272-5132
Mailing Address - Fax:
Practice Address - Street 1:22405 W BUSH RD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85735
Practice Address - Country:US
Practice Address - Phone:520-272-5132
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-15
Last Update Date:2018-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1229314385HR2055X, 171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor
No385HR2055XRespite Care FacilityRespite CareRespite Care, Mental Illness, Child