Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TA0400X | Addiction Psychologist (Substance Use Disorder) |
NPI | 1639640766 |
---|---|
Provider Name | Lidia Janette Aguilar |
First Address | Lemon Grove, CA 91945-4221 |
Second Address | Oceanside, CA 92057-4434 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/12/2018 |
Last Update Date | 16/12/2018 |