Provider Demographics
NPI:1184954414
Name:AGUILAR, GRACIELA BELEN
Entity type:Individual
Prefix:MS
First Name:GRACIELA
Middle Name:BELEN
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 1:1800 N BRISTOL ST # C-488
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92706-3336
Mailing Address - Country:US
Mailing Address - Phone:714-574-3763
Mailing Address - Fax:
Practice Address - Street 1:2677 N MAIN ST STE 110
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92705-6663
Practice Address - Country:US
Practice Address - Phone:714-274-7577
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-08
Last Update Date:2024-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA128208106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist