Healthcare Provider Details

I. General information

NPI: 1053982538
Provider Name (Legal Business Name): CARLOS EMILIO AGUILAR BOLONA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2021
Last Update Date: 07/16/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2951 NW 49TH AVE STE 101
LAUDERDALE LAKES FL
33313-1638
US

IV. Provider business mailing address

2951 NW 49TH AVE STE 101
LAUDERDALE LAKES FL
33313-1638
US

V. Phone/Fax

Practice location:
  • Phone: 954-739-2511
  • Fax: 954-739-9239
Mailing address:
  • Phone: 954-739-2511
  • Fax: 954-739-9239

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberME177928
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: