Provider Demographics
NPI:1336692938
Name:AGUIAR, STEPHANI
Entity Type:Individual
Prefix:
First Name:STEPHANI
Middle Name:
Last Name:AGUIAR
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 1:10200 LEHIGH AVE
Mailing Address - Street 2:
Mailing Address - City:MONTCLAIR
Mailing Address - State:CA
Mailing Address - Zip Code:91763-3550
Mailing Address - Country:US
Mailing Address - Phone:909-445-1616
Mailing Address - Fax:909-445-1620
Practice Address - Street 1:10200 LEHIGH AVE
Practice Address - Street 2:
Practice Address - City:MONTCLAIR
Practice Address - State:CA
Practice Address - Zip Code:91763-3550
Practice Address - Country:US
Practice Address - Phone:909-445-1616
Practice Address - Fax:909-445-1620
Is Sole Proprietor?:No
Enumeration Date:2016-07-31
Last Update Date:2016-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator