Healthcare Provider Details

I. General information

NPI: 1851306724
Provider Name (Legal Business Name): JACQUELINE B. AGUILUZ, D.O. INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/29/2006
Last Update Date: 01/31/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21508 NORWALK BLVD
HAWAIIAN GARDENS CA
90716-1122
US

IV. Provider business mailing address

21508 NORWALK BLVD
HAWAIIAN GARDENS CA
90716-1122
US

V. Phone/Fax

Practice location:
  • Phone: 562-865-5214
  • Fax: 562-865-3619
Mailing address:
  • Phone: 562-865-5214
  • Fax: 562-865-3619

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number20A7451
License Number StateCA

VIII. Authorized Official

Name: MRS. JACQUELINE B. AGUILUZ
Title or Position: PRESIDENT
Credential: D.O.
Phone: 56286552214