Healthcare Provider Details

I. General information

NPI: 1881195899
Provider Name (Legal Business Name): LOUIS AGUILAR-IGLESIAS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/25/2018
Last Update Date: 04/13/2023
Certification Date: 04/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

523 MACARTHUR DR
DALY CITY CA
94015-2004
US

IV. Provider business mailing address

523 MACARTHUR DR
DALY CITY CA
94015-2004
US

V. Phone/Fax

Practice location:
  • Phone: 415-297-2984
  • Fax:
Mailing address:
  • Phone: 415-297-2984
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: