Provider Demographics
NPI:1265283865
Name:AGUILAR, MARTHA
Entity type:Individual
Prefix:
First Name:MARTHA
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 1:6929 COLDWATER CANYON AVE APT 107
Mailing Address - Street 2:
Mailing Address - City:NORTH HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:91605-5148
Mailing Address - Country:US
Mailing Address - Phone:818-824-1261
Mailing Address - Fax:
Practice Address - Street 1:6929 COLDWATER CANYON AVE APT 107
Practice Address - Street 2:
Practice Address - City:NORTH HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:91605-5148
Practice Address - Country:US
Practice Address - Phone:818-824-1261
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-01
Last Update Date:2024-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95361059163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse