MEDICARE: JESUS LOPEZ AGUILAR

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	376K00000X	Nurse's Aide	UT014274401399	UT

General Provider Information

NPI Number	:	1760287338
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESUS LOPEZ AGUILAR

Provider Business Mailing Address
First Line	:	6416 W NEWTON FARM DR
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84128-2408
Country	:	US
Telephone Number	:	213-369-9006
Fax Number	:

Provider Business Practice Location Address
First Line	:	6416 W NEWTON FARM DR
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84128-2408
Country	:	US
Telephone Number	:	213-369-9006
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/17/2025
Last Update Date	:	02/17/2025

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