Provider Demographics
NPI:1720283211
Name:DEL AGUILA, FABIOLA (PHD)
Entity Type:Individual
Prefix:DR
First Name:FABIOLA
Middle Name:
Last Name:DEL AGUILA
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 E BROADWAY STE 400
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-3104
Mailing Address - Country:US
Mailing Address - Phone:541-357-9764
Mailing Address - Fax:
Practice Address - Street 1:101 E BROADWAY STE 400
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-3104
Practice Address - Country:US
Practice Address - Phone:541-357-9764
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-15
Last Update Date:2024-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA24471103T00000X
OR1108103TC0700X
OR3797103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist