Provider Demographics
NPI:1891485140
Name:AGUILAR, MARLENIS
Entity Type:Individual
Prefix:
First Name:MARLENIS
Middle Name:
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 1:4658 W IMPERIAL HWY APT 4
Mailing Address - Street 2:
Mailing Address - City:INGLEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90304-2648
Mailing Address - Country:US
Mailing Address - Phone:323-602-7808
Mailing Address - Fax:
Practice Address - Street 1:11096 JEFFERSON BLVD
Practice Address - Street 2:
Practice Address - City:CULVER CITY
Practice Address - State:CA
Practice Address - Zip Code:90230-5520
Practice Address - Country:US
Practice Address - Phone:310-397-3931
Practice Address - Fax:310-397-0381
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-10
Last Update Date:2023-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA49623183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician