Provider Demographics
NPI:1942935101
Name:AGUILAR, LISA R
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:R
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 1:4042 HICKS RD
Mailing Address - Street 2:
Mailing Address - City:GRANDVIEW
Mailing Address - State:WA
Mailing Address - Zip Code:98930-9165
Mailing Address - Country:US
Mailing Address - Phone:509-882-4260
Mailing Address - Fax:509-882-6088
Practice Address - Street 1:240 DIVISION ST
Practice Address - Street 2:
Practice Address - City:GRANDVIEW
Practice Address - State:WA
Practice Address - Zip Code:98930-1357
Practice Address - Country:US
Practice Address - Phone:509-882-4260
Practice Address - Fax:509-882-6088
Is Sole Proprietor?:No
Enumeration Date:2022-07-21
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator