Provider Demographics
NPI:1669097622
Name:AGUILAR, ESTEFANIA (PA-C)
Entity type:Individual
Prefix:
First Name:ESTEFANIA
Middle Name:
Last Name:AGUILAR
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:ESTEFANIA
Other - Middle Name:
Other - Last Name:AGUILAR-ARIAS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PA-C
Mailing Address - Street 1:6828 W TUPELO LN
Mailing Address - Street 2:
Mailing Address - City:WEST JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84081-4189
Mailing Address - Country:US
Mailing Address - Phone:801-898-3450
Mailing Address - Fax:
Practice Address - Street 1:175 NORTH MEDICAL DRIVE EAST
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84132-4189
Practice Address - Country:US
Practice Address - Phone:801-581-6908
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-15
Last Update Date:2021-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT12478786-1206363A00000X
363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical