Provider Demographics
NPI:1053136705
Name:LONG, AIDE SILVA
Entity type:Individual
Prefix:
First Name:AIDE
Middle Name:SILVA
Last Name:LONG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:AIDE
Other - Middle Name:
Other - Last Name:SILVA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7077 ORANGEWOOD AVE STE 140
Mailing Address - Street 2:
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92841-1439
Mailing Address - Country:US
Mailing Address - Phone:714-907-4514
Mailing Address - Fax:
Practice Address - Street 1:7077 ORANGEWOOD AVE STE 140
Practice Address - Street 2:
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92841-1439
Practice Address - Country:US
Practice Address - Phone:714-907-4514
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-18
Last Update Date:2024-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA171M00000X, 172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker
No171M00000XOther Service ProvidersCase Manager/Care Coordinator