Provider Demographics
NPI:1659155463
Name:AGUAYO, ANGELA JAYNELLI
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:JAYNELLI
Last Name:AGUAYO
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 1:18055 KIMBERLY SUE CT
Mailing Address - Street 2:
Mailing Address - City:LAKE ELSINORE
Mailing Address - State:CA
Mailing Address - Zip Code:92532-1958
Mailing Address - Country:US
Mailing Address - Phone:951-306-8434
Mailing Address - Fax:
Practice Address - Street 1:18055 KIMBERLY SUE CT
Practice Address - Street 2:
Practice Address - City:LAKE ELSINORE
Practice Address - State:CA
Practice Address - Zip Code:92532-1958
Practice Address - Country:US
Practice Address - Phone:951-306-8434
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-22
Last Update Date:2023-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician