Provider Demographics
NPI:1982339651
Name:AGUILERA, MARTHA
Entity Type:Individual
Prefix:
First Name:MARTHA
Middle Name:
Last Name:AGUILERA
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 1:72490 EL CENTRO WAY APT K132
Mailing Address - Street 2:
Mailing Address - City:THOUSAND PALMS
Mailing Address - State:CA
Mailing Address - Zip Code:92276-3431
Mailing Address - Country:US
Mailing Address - Phone:760-580-5915
Mailing Address - Fax:
Practice Address - Street 1:72490 EL CENTRO WAY APT K132
Practice Address - Street 2:
Practice Address - City:THOUSAND PALMS
Practice Address - State:CA
Practice Address - Zip Code:92276-3431
Practice Address - Country:US
Practice Address - Phone:760-580-5915
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-18
Last Update Date:2022-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty