Healthcare Provider Details

I. General information

NPI: 1770604662
Provider Name (Legal Business Name): CORAZON T AGUILAR, MD, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/02/2007
Last Update Date: 06/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1550 S POTOMAC ST STE 230
AURORA CO
80012-5455
US

IV. Provider business mailing address

1550 S POTOMAC ST STE 230
AURORA CO
80012-5455
US

V. Phone/Fax

Practice location:
  • Phone: 303-369-1077
  • Fax: 303-369-9785
Mailing address:
  • Phone: 303-369-1077
  • Fax: 303-369-8795

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code302F00000X
TaxonomyExclusive Provider Organization
License Number19924
License Number StateCO

VIII. Authorized Official

Name: VANNEHE EICH
Title or Position: OPERATIONS
Credential:
Phone: 303-369-1077