Provider Demographics
NPI:1790396794
Name:AGUILAR, HEIDI (NP)
Entity Type:Individual
Prefix:MRS
First Name:HEIDI
Middle Name:
Last Name:AGUILAR
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23331 EL TORO RD STE 104
Mailing Address - Street 2:
Mailing Address - City:LAKE FOREST
Mailing Address - State:CA
Mailing Address - Zip Code:92630-4809
Mailing Address - Country:US
Mailing Address - Phone:949-382-2782
Mailing Address - Fax:
Practice Address - Street 1:23331 EL TORO RD STE 104
Practice Address - Street 2:
Practice Address - City:LAKE FOREST
Practice Address - State:CA
Practice Address - Zip Code:92630-4809
Practice Address - Country:US
Practice Address - Phone:949-382-2782
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-12
Last Update Date:2022-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95015102363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health