Healthcare Provider Details

I. General information

NPI: 1013704543
Provider Name (Legal Business Name): MIGUEL A AGUILAR JR.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/21/2025
Last Update Date: 04/21/2025
Certification Date: 04/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2085 RUSTIN AVE
RIVERSIDE CA
92507-2498
US

IV. Provider business mailing address

13295 PAN AM BLVD
MORENO VALLEY CA
92553-6431
US

V. Phone/Fax

Practice location:
  • Phone: 951-955-7170
  • Fax:
Mailing address:
  • Phone: 951-892-2505
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: