Provider Demographics
NPI:1609367200
Name:AGUILAR, JENNY
Entity Type:Individual
Prefix:
First Name:JENNY
Middle Name:
Last Name:AGUILAR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1545 WIGWAM PKWY APT 2918
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89074-8291
Mailing Address - Country:US
Mailing Address - Phone:323-712-0630
Mailing Address - Fax:
Practice Address - Street 1:1545 WIGWAM PKWY APT 2918
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89074-8291
Practice Address - Country:US
Practice Address - Phone:323-712-0630
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-20
Last Update Date:2018-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program