Healthcare Provider Details

I. General information

NPI: 1366266850
Provider Name (Legal Business Name): WENDY AGUILAR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/11/2024
Last Update Date: 11/11/2024
Certification Date: 11/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12235 PINES BLVD
PEMBROKE PINES FL
33026-4119
US

IV. Provider business mailing address

2319 N 37TH AVE
HOLLYWOOD FL
33021-3602
US

V. Phone/Fax

Practice location:
  • Phone: 954-265-4325
  • Fax:
Mailing address:
  • Phone: 786-274-0903
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086X0206X
TaxonomySurgical Oncology Physician
License Number11035252
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: