Basic Information
| Provider Information | |||||||||
| NPI: | 1780016071 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | AGUILAR | ||||||||
| FirstName: | JIMMY | ||||||||
| MiddleName: | STEVE | ||||||||
| NamePrefix: | MR. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 22710 8TH ST | ||||||||
| Address2: | APT 204-A | ||||||||
| City: | NEWHALL | ||||||||
| State: | CA | ||||||||
| PostalCode: | 913212947 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6613731033 | ||||||||
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| Practice Location | |||||||||
| Address1: | 828 W VENTURA ST | ||||||||
| Address2: | |||||||||
| City: | FILLMORE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 930151876 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8055242000 | ||||||||
| FaxNumber: | 8055249601 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/08/2013 | ||||||||
| LastUpdateDate: | 08/08/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106H00000X | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.