Basic Information
| Provider Information | |||||||||
| NPI: | 1437434693 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | AGUILA | ||||||||
| FirstName: | JENNIFER | ||||||||
| MiddleName: | VERGARA | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | ARNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7240 E YALE AVE | ||||||||
| Address2: | |||||||||
| City: | FRESNO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 937370007 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9046548725 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 951 MARINERS ISLAND BLVD STE 300 | ||||||||
| Address2: | |||||||||
| City: | SAN MATEO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 944041560 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7722174557 | ||||||||
| FaxNumber: | 8883527383 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/19/2011 | ||||||||
| LastUpdateDate: | 03/16/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 03/16/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 21338 | CA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.