Provider Demographics
NPI:1477143915
Name:AGUILA, EILEEN JANE (HA7079)
Entity Type:Individual
Prefix:MRS
First Name:EILEEN
Middle Name:JANE
Last Name:AGUILA
Suffix:
Gender:F
Credentials:HA7079
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4015 GOVERNOR DR
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92122-2522
Mailing Address - Country:US
Mailing Address - Phone:858-458-9019
Mailing Address - Fax:858-458-9268
Practice Address - Street 1:4015 GOVERNOR DR
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92122-2522
Practice Address - Country:US
Practice Address - Phone:858-458-9019
Practice Address - Fax:858-458-9268
Is Sole Proprietor?:No
Enumeration Date:2021-01-19
Last Update Date:2021-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAHA7079237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist