Provider Demographics
NPI:1457015869
Name:AGUILERA, DIANA GABRIELA (MS, RDN)
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:GABRIELA
Last Name:AGUILERA
Suffix:
Gender:F
Credentials:MS, RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36075 S RINCON RD
Mailing Address - Street 2:
Mailing Address - City:WICKENBURG
Mailing Address - State:AZ
Mailing Address - Zip Code:85390-2491
Mailing Address - Country:US
Mailing Address - Phone:928-223-6084
Mailing Address - Fax:
Practice Address - Street 1:36075 S RINCON RD
Practice Address - Street 2:
Practice Address - City:WICKENBURG
Practice Address - State:AZ
Practice Address - Zip Code:85390-2491
Practice Address - Country:US
Practice Address - Phone:928-223-6084
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-22
Last Update Date:2022-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
86146940133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty