Provider Demographics
NPI:1831276575
Name:AGUILUZ, KATHLYN ROSE (RN)
Entity type:Individual
Prefix:
First Name:KATHLYN
Middle Name:ROSE
Last Name:AGUILUZ
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:KATHLYN
Other - Middle Name:ROSE
Other - Last Name:PANTIG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:910 EUCLID AVE
Mailing Address - Street 2:APT 134
Mailing Address - City:NATIONAL CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91950-3834
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3853 ROSECRANS ST
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92110-3115
Practice Address - Country:US
Practice Address - Phone:619-692-8225
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA694628163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse