Provider Demographics
NPI:1407613946
Name:AGUILAR, PHOENIX SKYY
Entity Type:Individual
Prefix:
First Name:PHOENIX
Middle Name:SKYY
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 1:13602 N 44TH ST APT 188
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85032-6372
Mailing Address - Country:US
Mailing Address - Phone:425-240-4422
Mailing Address - Fax:
Practice Address - Street 1:13602 N 44TH ST APT 188
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85032-6372
Practice Address - Country:US
Practice Address - Phone:425-240-4422
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-01
Last Update Date:2024-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer