Healthcare Provider Details

I. General information

NPI: 1093475543
Provider Name (Legal Business Name): VLADIMIR AGUILAR ACNPC-AG
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/25/2021
Last Update Date: 06/18/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9961 SIERRA AVE
FONTANA CA
92335-6720
US

IV. Provider business mailing address

8442 VIA NORTE DR
RIVERSIDE CA
92503-7825
US

V. Phone/Fax

Practice location:
  • Phone: 951-452-3202
  • Fax:
Mailing address:
  • Phone: 951-452-3202
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number95077925
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number723430
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number1644461
License Number StateCO
# 4
Primary TaxonomyY
Taxonomy Code363LC0200X
TaxonomyCritical Care Medicine Nurse Practitioner
License Number95018916
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: