Provider Demographics
NPI:1437353810
Name:AGUILAR, SOPHIA
Entity Type:Individual
Prefix:MRS
First Name:SOPHIA
Middle Name:
Last Name:AGUILAR
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:SOPHIA
Other - Middle Name:
Other - Last Name:AGUILAR
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RDHAP
Mailing Address - Street 1:695 CRESCENT LN
Mailing Address - Street 2:
Mailing Address - City:LEMOORE
Mailing Address - State:CA
Mailing Address - Zip Code:93245-4953
Mailing Address - Country:US
Mailing Address - Phone:559-924-0500
Mailing Address - Fax:
Practice Address - Street 1:695 CRESCENT LN
Practice Address - Street 2:
Practice Address - City:LEMOORE
Practice Address - State:CA
Practice Address - Zip Code:93245-4953
Practice Address - Country:US
Practice Address - Phone:559-924-0500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA18726124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAH00043OtherHEALTHY FAMILIES ID#