Healthcare Provider Details

I. General information

NPI: 1922133354
Provider Name (Legal Business Name): ELSA M. AGUILAR M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/23/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 S ANAHEIM HILLS RD SUITE 110
ANAHEIM CA
92807-4780
US

IV. Provider business mailing address

500 S ANAHEIM HILLS RD SUITE 110
ANAHEIM CA
92807-4780
US

V. Phone/Fax

Practice location:
  • Phone: 714-282-2229
  • Fax: 714-282-7145
Mailing address:
  • Phone: 714-282-2229
  • Fax: 714-282-7145

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License NumberG54577
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: