Healthcare Provider Details

I. General information

NPI: 1831077585
Provider Name (Legal Business Name): EDWIN AGUILAR
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/21/2025
Last Update Date: 08/21/2025
Certification Date: 08/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8790 CUYAMACA ST
SANTEE CA
92071-4295
US

IV. Provider business mailing address

222 LOS REYES DR
SAN DIEGO CA
92114-4512
US

V. Phone/Fax

Practice location:
  • Phone: 619-596-5969
  • Fax:
Mailing address:
  • Phone: 619-767-8057
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081S0010X
TaxonomySports Medicine (Physical Medicine & Rehabilitation) Physician
License Number52646
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: