Provider Demographics
NPI:1457024689
Name:AGUILLON, MARJORIEANN CORPUS (LVN, LPN)
Entity Type:Individual
Prefix:
First Name:MARJORIEANN
Middle Name:CORPUS
Last Name:AGUILLON
Suffix:
Gender:F
Credentials:LVN, LPN
Other - Prefix:
Other - First Name:MARJORIEANN
Other - Middle Name:AGUILLON
Other - Last Name:LOWE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LVN, LPN
Mailing Address - Street 1:665 WALNUT AVE
Mailing Address - Street 2:VCUSD- VALLEJO CITY UNIFIED SCHOOL DISTRICT
Mailing Address - City:VALLEJO
Mailing Address - State:CA
Mailing Address - Zip Code:94592-1177
Mailing Address - Country:US
Mailing Address - Phone:707-556-8921
Mailing Address - Fax:707-638-3501
Practice Address - Street 1:665 WALNUT AVE
Practice Address - Street 2:VCUSD- VALLEJO CITY UNIFIED SCHOOL DISTRICT
Practice Address - City:VALLEJO
Practice Address - State:CA
Practice Address - Zip Code:94592-1177
Practice Address - Country:US
Practice Address - Phone:707-556-8921
Practice Address - Fax:707-638-3501
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-25
Last Update Date:2022-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALP60918760164W00000X
CA253088164X00000X
CAVN253088164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse
No164W00000XNursing Service ProvidersLicensed Practical Nurse