Provider Demographics
NPI:1205343944
Name:AGUILAR, THERESA RAE (MD, MPH)
Entity type:Individual
Prefix:
First Name:THERESA
Middle Name:RAE
Last Name:AGUILAR
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Gender:
Credentials:MD, MPH
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Mailing Address - Street 1:1179 N MCDOWELL BLVD
Mailing Address - Street 2:
Mailing Address - City:PETALUMA
Mailing Address - State:CA
Mailing Address - Zip Code:94954-6559
Mailing Address - Country:US
Mailing Address - Phone:707-559-7500
Mailing Address - Fax:
Practice Address - Street 1:1179 N MCDOWELL BLVD
Practice Address - Street 2:
Practice Address - City:PETALUMA
Practice Address - State:CA
Practice Address - Zip Code:94954-6559
Practice Address - Country:US
Practice Address - Phone:707-559-7500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-03
Last Update Date:2025-02-18
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MA289482207Q00000X
CAA196655207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA196655OtherCA MEDICAL LICENSE