Provider Demographics
NPI:1518749498
Name:VILA AGUILA, LAURA BEATRIZ
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:BEATRIZ
Last Name:VILA AGUILA
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 1:9934 AQUARIUS DR UNIT M
Mailing Address - Street 2:
Mailing Address - City:PORT RICHEY
Mailing Address - State:FL
Mailing Address - Zip Code:34668-3503
Mailing Address - Country:US
Mailing Address - Phone:727-902-5384
Mailing Address - Fax:
Practice Address - Street 1:9934 AQUARIUS DR UNIT M
Practice Address - Street 2:
Practice Address - City:PORT RICHEY
Practice Address - State:FL
Practice Address - Zip Code:34668-3503
Practice Address - Country:US
Practice Address - Phone:727-902-5384
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-16
Last Update Date:2024-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RBT-23-301539106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician