Healthcare Provider Details

I. General information

NPI: 1821929159
Provider Name (Legal Business Name): AQUARIUS SURGICAL CONSULTING SERVICES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/26/2026
Last Update Date: 05/26/2026
Certification Date: 05/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1503 N IMPERIAL AVE STE 105
EL CENTRO CA
92243-6302
US

IV. Provider business mailing address

PO BOX 2280
EL CENTRO CA
92244-2280
US

V. Phone/Fax

Practice location:
  • Phone: 760-693-5372
  • Fax: 760-693-5375
Mailing address:
  • Phone: 760-460-6425
  • Fax: 760-332-4800

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086X0206X
TaxonomySurgical Oncology Physician
License Number
License Number State

VIII. Authorized Official

Name: JULIE FLORES
Title or Position: COO
Credential:
Phone: 760-460-6425