Provider Demographics
NPI:1558429704
Name:AGUILA, JUANCARLOS
Entity Type:Individual
Prefix:
First Name:JUANCARLOS
Middle Name:
Last Name:AGUILA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:JUAN-CARLOS
Other - Middle Name:
Other - Last Name:AGUILA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW
Mailing Address - Street 1:160 E VIRGINIA ST
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95112-5857
Mailing Address - Country:US
Mailing Address - Phone:408-918-2618
Mailing Address - Fax:408-579-6143
Practice Address - Street 1:160 E VIRGINIA ST
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95112-5857
Practice Address - Country:US
Practice Address - Phone:408-918-2618
Practice Address - Fax:408-579-6143
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-04
Last Update Date:2017-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA178931041C0700X
CA750331041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical