Provider Demographics
NPI:1518587302
Name:AQUILLAS, CLER VICENTINA (NP)
Entity type:Individual
Prefix:
First Name:CLER
Middle Name:VICENTINA
Last Name:AQUILLAS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:530 HOLLY HOCK CIR
Mailing Address - Street 2:
Mailing Address - City:PATTERSON
Mailing Address - State:CA
Mailing Address - Zip Code:95363-9444
Mailing Address - Country:US
Mailing Address - Phone:773-954-1248
Mailing Address - Fax:
Practice Address - Street 1:1108 WARD AVE STE 1
Practice Address - Street 2:
Practice Address - City:PATTERSON
Practice Address - State:CA
Practice Address - Zip Code:95363-8529
Practice Address - Country:US
Practice Address - Phone:773-954-1248
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-21
Last Update Date:2020-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95014166363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily