Provider Demographics
NPI:1881254035
Name:AGUILAR, KASSANDRA DE JESUS
Entity type:Individual
Prefix:
First Name:KASSANDRA
Middle Name:DE JESUS
Last Name:AGUILAR
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 1:562 SAINT VINCENT
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92618-3933
Mailing Address - Country:US
Mailing Address - Phone:562-541-4753
Mailing Address - Fax:
Practice Address - Street 1:562 SAINT VINCENT
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92618-3933
Practice Address - Country:US
Practice Address - Phone:562-541-4753
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-19
Last Update Date:2019-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician