Provider Demographics
NPI:1205535689
Name:AGUILAR, ISRAEL REYNA (MS, RDN)
Entity type:Individual
Prefix:
First Name:ISRAEL
Middle Name:REYNA
Last Name:AGUILAR
Suffix:
Gender:M
Credentials:MS, RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25172 WILEY CANYON RD
Mailing Address - Street 2:
Mailing Address - City:NEWHALL
Mailing Address - State:CA
Mailing Address - Zip Code:91321-2324
Mailing Address - Country:US
Mailing Address - Phone:661-993-6025
Mailing Address - Fax:
Practice Address - Street 1:25172 WILEY CANYON RD
Practice Address - Street 2:
Practice Address - City:NEWHALL
Practice Address - State:CA
Practice Address - Zip Code:91321-2324
Practice Address - Country:US
Practice Address - Phone:661-993-6025
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-24
Last Update Date:2023-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA86169489133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered