Provider Demographics
NPI:1578680047
Name:AGUILLON, JACQUELINE CUAJAO (46720 DDS)
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:CUAJAO
Last Name:AGUILLON
Suffix:
Gender:F
Credentials:46720 DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1915 FREMONT AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91030-4507
Mailing Address - Country:US
Mailing Address - Phone:323-340-8882
Mailing Address - Fax:323-340-8886
Practice Address - Street 1:1915 FREMONT AVE
Practice Address - Street 2:
Practice Address - City:SOUTH PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91030-4507
Practice Address - Country:US
Practice Address - Phone:323-340-8882
Practice Address - Fax:626-421-7916
Is Sole Proprietor?:No
Enumeration Date:2007-03-22
Last Update Date:2020-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA467201223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAD46720Medicare ID - Type Unspecified