Healthcare Provider Details

I. General information

NPI: 1821953043
Provider Name (Legal Business Name): DIANA AGUILAR
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/19/2025
Last Update Date: 12/19/2025
Certification Date: 12/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10935 S JOG RD
BOYNTON BEACH FL
33437-3921
US

IV. Provider business mailing address

13941 FOLKESTONE CIR APT A
WELLINGTON FL
33414-7887
US

V. Phone/Fax

Practice location:
  • Phone: 561-731-2905
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPS69953
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: