Provider Demographics
NPI:1821391806
Name:AGUILAR, GAIL (LADAC)
Entity Type:Individual
Prefix:MRS
First Name:GAIL
Middle Name:
Last Name:AGUILAR
Suffix:
Gender:F
Credentials:LADAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P. O. BOX 4339
Mailing Address - Street 2:
Mailing Address - City:SAN FELIPE PUEBLO
Mailing Address - State:NM
Mailing Address - Zip Code:87001
Mailing Address - Country:US
Mailing Address - Phone:505-771-9956
Mailing Address - Fax:505-867-6166
Practice Address - Street 1:18 COUGAR ROAD
Practice Address - Street 2:SAN FELIPE BEHAVIORAL HEALTH PROGRAM
Practice Address - City:SAN FELIPE
Practice Address - State:NM
Practice Address - Zip Code:87001
Practice Address - Country:US
Practice Address - Phone:505-771-9956
Practice Address - Fax:505-867-6166
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-13
Last Update Date:2010-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0132011101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)