Provider Demographics
NPI:1598453482
Name:AGUILAR-CRONQUIST, JOAQUIN BRENDAN
Entity Type:Individual
Prefix:MR
First Name:JOAQUIN
Middle Name:BRENDAN
Last Name:AGUILAR-CRONQUIST
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1950 POTTERY AVE STE S124
Mailing Address - Street 2:
Mailing Address - City:PORT ORCHARD
Mailing Address - State:WA
Mailing Address - Zip Code:98366-2590
Mailing Address - Country:US
Mailing Address - Phone:360-355-8669
Mailing Address - Fax:
Practice Address - Street 1:1950 POTTERY AVE STE S124
Practice Address - Street 2:
Practice Address - City:PORT ORCHARD
Practice Address - State:WA
Practice Address - Zip Code:98366-2590
Practice Address - Country:US
Practice Address - Phone:360-355-8669
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-27
Last Update Date:2023-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician