Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YA0400X | Addiction Counselor (Substance Use Disorder) | N2496468 | CA |
NPI | 1003193590 |
---|---|
Provider Name | Miss Sally Aguilar |
First Address | San Jose, CA 95111-1048 |
Second Address | San Jose, CA 95111-1048 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/11/2011 |
Last Update Date | 10/11/2011 |