Provider Demographics
NPI:1346525003
Name:AGUILAR, ELOISA (CNA)
Entity Type:Individual
Prefix:
First Name:ELOISA
Middle Name:
Last Name:AGUILAR
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9280 APHRODITE DR
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99515-1498
Mailing Address - Country:US
Mailing Address - Phone:907-339-0176
Mailing Address - Fax:907-339-0176
Practice Address - Street 1:9280 APHRODITE DR
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99515-1498
Practice Address - Country:US
Practice Address - Phone:907-339-0176
Practice Address - Fax:907-339-0176
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-13
Last Update Date:2011-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK100905172V00000X
AK955259172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker