Provider Demographics
NPI:1689868242
Name:AGUILAR, JACQUELINE DEPEDRO (DDS)
Entity Type:Individual
Prefix:DR
First Name:JACQUELINE
Middle Name:DEPEDRO
Last Name:AGUILAR
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 44396
Mailing Address - Street 2:
Mailing Address - City:PANORAMA CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91412-0396
Mailing Address - Country:US
Mailing Address - Phone:646-920-5851
Mailing Address - Fax:
Practice Address - Street 1:1141 PEAR TREE LN STE 120
Practice Address - Street 2:
Practice Address - City:NAPA
Practice Address - State:CA
Practice Address - Zip Code:94558-6485
Practice Address - Country:US
Practice Address - Phone:707-258-6128
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-28
Last Update Date:2022-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY05346511223G0001X
CA106962122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice