Healthcare Provider Details

I. General information

NPI: 1104935329
Provider Name (Legal Business Name): JORGE LOPEZ-AGUADO M.D/
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 09/09/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

49430 ROAD 426 SUITE B
OAKHURST CA
93644-8618
US

IV. Provider business mailing address

PO BOX 2588
OAKHURST CA
93644-2588
US

V. Phone/Fax

Practice location:
  • Phone: 559-683-2459
  • Fax:
Mailing address:
  • Phone: 559-683-2459
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberF39744
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: