Provider Demographics
NPI:1295955466
Name:DAVID, ALEXIS AGUILAN (BA, BS)
Entity type:Individual
Prefix:MISS
First Name:ALEXIS
Middle Name:AGUILAN
Last Name:DAVID
Suffix:
Gender:F
Credentials:BA, BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:339 ALLISON ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94112-4312
Mailing Address - Country:US
Mailing Address - Phone:415-541-9404
Mailing Address - Fax:
Practice Address - Street 1:339 ALLISON ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94112-4312
Practice Address - Country:US
Practice Address - Phone:415-541-9404
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA38BF3Medicaid