Provider Demographics
NPI:1508330390
Name:AGUILAR, JESSICA (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:AGUILAR
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6710 VARIEL AVE APT 404
Mailing Address - Street 2:
Mailing Address - City:WOODLAND HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91303-4806
Mailing Address - Country:US
Mailing Address - Phone:818-437-9199
Mailing Address - Fax:
Practice Address - Street 1:1234 N VERMONT AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90029-1704
Practice Address - Country:US
Practice Address - Phone:323-660-0831
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-15
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95009311363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA95009311OtherCALIFORNIA BOARD OF REGISTERED NURSING
CAMA5094420OtherDRUG ENFORCEMENT ADMINISTRATION