Provider Demographics
NPI:1255071064
Name:AGUILAR, ELEXIS
Entity type:Individual
Prefix:
First Name:ELEXIS
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 1:550 W VISTA WAY STE 407
Mailing Address - Street 2:
Mailing Address - City:VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:92083-5714
Mailing Address - Country:US
Mailing Address - Phone:760-758-1092
Mailing Address - Fax:760-758-8481
Practice Address - Street 1:550 W VISTA WAY STE 407
Practice Address - Street 2:
Practice Address - City:VISTA
Practice Address - State:CA
Practice Address - Zip Code:92083-5714
Practice Address - Country:US
Practice Address - Phone:760-758-1092
Practice Address - Fax:760-758-8481
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-30
Last Update Date:2025-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X, 225400000X, 171M00000X
CAMPSS-GZXTOW175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No175T00000XOther Service ProvidersPeer Specialist
No225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner