Provider Demographics
NPI:1215811799
Name:AGUILAR NUNEZ, SELENA
Entity type:Individual
Prefix:
First Name:SELENA
Middle Name:
Last Name:AGUILAR NUNEZ
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 1:2627 AZTEC ST
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95403-3271
Mailing Address - Country:US
Mailing Address - Phone:707-548-4757
Mailing Address - Fax:
Practice Address - Street 1:110 STONY POINT RD STE 210
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95401-4118
Practice Address - Country:US
Practice Address - Phone:707-890-3800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-05
Last Update Date:2025-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA14181101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health