Provider Demographics
NPI:1457082810
Name:INGUANZO, ARISTY
Entity Type:Individual
Prefix:
First Name:ARISTY
Middle Name:
Last Name:INGUANZO
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 1:635 N LOARA ST APT W2
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92801-4603
Mailing Address - Country:US
Mailing Address - Phone:714-909-8932
Mailing Address - Fax:
Practice Address - Street 1:635 N LOARA ST APT W2
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92801-4603
Practice Address - Country:US
Practice Address - Phone:714-909-8932
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-17
Last Update Date:2022-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty