Provider Demographics
NPI:1619537768
Name:AGUILAR, ANGELA TRINIDAD
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:TRINIDAD
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 1:9390 SW LINE DR # 9390
Mailing Address - Street 2:
Mailing Address - City:CORNELIUS
Mailing Address - State:OR
Mailing Address - Zip Code:97113-9610
Mailing Address - Country:US
Mailing Address - Phone:971-724-4034
Mailing Address - Fax:000-000-0000
Practice Address - Street 1:5801 NE CORNELIUS PASS RD # 5801
Practice Address - Street 2:
Practice Address - City:HILLSBORO
Practice Address - State:OR
Practice Address - Zip Code:97124-9370
Practice Address - Country:US
Practice Address - Phone:971-762-1144
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-19
Last Update Date:2019-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORA669160106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician