Provider Demographics
NPI:1518977925
Name:AGUILA, LORENA Y (PHD)
Entity Type:Individual
Prefix:
First Name:LORENA
Middle Name:Y
Last Name:AGUILA
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3025 BEYER BLVD STE E-102
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92154-3432
Mailing Address - Country:US
Mailing Address - Phone:619-428-1000
Mailing Address - Fax:619-428-1091
Practice Address - Street 1:3025 BEYER BLVD STE E-102
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92154-3432
Practice Address - Country:US
Practice Address - Phone:619-428-1000
Practice Address - Fax:619-428-1091
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY20030103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical