Healthcare Provider Details

I. General information

NPI: 1861025033
Provider Name (Legal Business Name): LUISA AGUILA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/17/2020
Last Update Date: 04/19/2024
Certification Date: 04/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2020 W 64TH ST
HIALEAH FL
33016-2607
US

IV. Provider business mailing address

1100 E 6TH CT
HIALEAH FL
33010-3622
US

V. Phone/Fax

Practice location:
  • Phone: 305-642-5366
  • Fax: 305-644-6407
Mailing address:
  • Phone: 786-417-1281
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPRN11006166
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: