Provider Demographics
NPI:1376262667
Name:AGUILAR, JOSE JAVIER
Entity Type:Individual
Prefix:
First Name:JOSE
Middle Name:JAVIER
Last Name:AGUILAR
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24386 THOMAS AVE
Mailing Address - Street 2:
Mailing Address - City:HAYWARD
Mailing Address - State:CA
Mailing Address - Zip Code:94544-1552
Mailing Address - Country:US
Mailing Address - Phone:707-666-5595
Mailing Address - Fax:
Practice Address - Street 1:2633 E 27TH ST
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94601-1912
Practice Address - Country:US
Practice Address - Phone:510-536-8111
Practice Address - Fax:510-536-0166
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-22
Last Update Date:2022-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA29865167G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes167G00000XNursing Service ProvidersLicensed Psychiatric Technician