Provider Demographics
NPI:1801210984
Name:AGUILERA, ALFREDO JR
Entity Type:Individual
Prefix:
First Name:ALFREDO
Middle Name:
Last Name:AGUILERA
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:426 S 8TH ST
Mailing Address - Street 2:
Mailing Address - City:DONNA
Mailing Address - State:TX
Mailing Address - Zip Code:78537-3141
Mailing Address - Country:US
Mailing Address - Phone:956-373-1323
Mailing Address - Fax:
Practice Address - Street 1:426 S 8TH ST
Practice Address - Street 2:
Practice Address - City:DONNA
Practice Address - State:TX
Practice Address - Zip Code:78537-3141
Practice Address - Country:US
Practice Address - Phone:956-373-1323
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-11
Last Update Date:2014-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX68816101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional