Provider Demographics
NPI:1144934613
Name:ARAGON PRUDENCIO, KAREN ISELA
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:ISELA
Last Name:ARAGON PRUDENCIO
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 1:11465 RUGGIERO AVE
Mailing Address - Street 2:
Mailing Address - City:SYLMAR
Mailing Address - State:CA
Mailing Address - Zip Code:91342-6737
Mailing Address - Country:US
Mailing Address - Phone:323-303-2588
Mailing Address - Fax:
Practice Address - Street 1:224 W DRYDEN ST
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91202-3748
Practice Address - Country:US
Practice Address - Phone:323-303-2588
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-10
Last Update Date:2023-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAF3011241OtherCA DL