Healthcare Provider Details

I. General information

NPI: 1649739772
Provider Name (Legal Business Name): ADRIAN ZABDIEL AGUDELO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/18/2019
Last Update Date: 07/29/2022
Certification Date: 07/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4445 MAGNOLIA AVE
RIVERSIDE CA
92501-4135
US

IV. Provider business mailing address

10925 MORO ST
LOMA LINDA CA
92354-6109
US

V. Phone/Fax

Practice location:
  • Phone: 951-788-3537
  • Fax:
Mailing address:
  • Phone: 352-359-5128
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberA177461
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: