Healthcare Provider Details

I. General information

NPI: 1457377152
Provider Name (Legal Business Name): CORAZON T AGUILAR M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2006
Last Update Date: 11/26/2018
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: 303-369-9785

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number19912
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: