Provider Demographics
NPI:1609498930
Name:AGUILAR, TINA M (CMT)
Entity type:Individual
Prefix:
First Name:TINA
Middle Name:M
Last Name:AGUILAR
Suffix:
Gender:F
Credentials:CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1231 8TH ST STE 420
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95354-2226
Mailing Address - Country:US
Mailing Address - Phone:209-332-3244
Mailing Address - Fax:
Practice Address - Street 1:1231 8TH ST STE 420
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95354-2226
Practice Address - Country:US
Practice Address - Phone:209-332-3244
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-08
Last Update Date:2020-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA16302225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist