Provider Demographics
NPI:1790119931
Name:AGUILAR, JACQUELINE ADELA
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:ADELA
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 1:1201 N CATALINA AVE UNIT 4083
Mailing Address - Street 2:
Mailing Address - City:REDONDO BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90277-8308
Mailing Address - Country:US
Mailing Address - Phone:951-333-4627
Mailing Address - Fax:
Practice Address - Street 1:2447 PACIFIC COAST HWY FL 2
Practice Address - Street 2:
Practice Address - City:HERMOSA BEACH
Practice Address - State:CA
Practice Address - Zip Code:90254-2743
Practice Address - Country:US
Practice Address - Phone:951-333-4627
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-23
Last Update Date:2022-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCSW986861041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical