Provider Demographics
NPI:1417696261
Name:AGUILERA, DIANA MARIELA (AG-ACNP)
Entity Type:Individual
Prefix:MRS
First Name:DIANA
Middle Name:MARIELA
Last Name:AGUILERA
Suffix:
Gender:F
Credentials:AG-ACNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2664 CALLE OLIVO
Mailing Address - Street 2:
Mailing Address - City:THOUSAND OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91360-6528
Mailing Address - Country:US
Mailing Address - Phone:805-630-1852
Mailing Address - Fax:
Practice Address - Street 1:2664 CALLE OLIVO
Practice Address - Street 2:
Practice Address - City:THOUSAND OAKS
Practice Address - State:CA
Practice Address - Zip Code:91360-6528
Practice Address - Country:US
Practice Address - Phone:805-630-1852
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-31
Last Update Date:2022-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA2022009842363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care