Provider Demographics
NPI:1598201287
Name:AGUILAR, CRYSTAL (NP)
Entity Type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:
Last Name:AGUILAR
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9330 WASHINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:PICO RIVERA
Mailing Address - State:CA
Mailing Address - Zip Code:90660-3838
Mailing Address - Country:US
Mailing Address - Phone:562-205-4200
Mailing Address - Fax:
Practice Address - Street 1:9330 WASHINGTON BLVD
Practice Address - Street 2:
Practice Address - City:PICO RIVERA
Practice Address - State:CA
Practice Address - Zip Code:90660-3838
Practice Address - Country:US
Practice Address - Phone:562-205-4200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-18
Last Update Date:2017-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95004973363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily