Provider Demographics
NPI:1861290702
Name:MENJIVAR-VARGAS, AARON FELICIANO (ACSW)
Entity type:Individual
Prefix:
First Name:AARON
Middle Name:FELICIANO
Last Name:MENJIVAR-VARGAS
Suffix:
Gender:M
Credentials:ACSW
Other - Prefix:
Other - First Name:AARON
Other - Middle Name:FELICIANO
Other - Last Name:MENJIVAR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ACSW
Mailing Address - Street 1:1042 N MOUNTAIN AVE STE B560
Mailing Address - Street 2:
Mailing Address - City:UPLAND
Mailing Address - State:CA
Mailing Address - Zip Code:91786-3695
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:9431 HAVEN AVE STE 100
Practice Address - Street 2:
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730-5879
Practice Address - Country:US
Practice Address - Phone:877-841-2034
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-06
Last Update Date:2025-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA125187104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker