Healthcare Provider Details

I. General information

NPI: 1043726565
Provider Name (Legal Business Name): LUCITA AGUILERA MT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: LUCITA AGUILERA DE LA PAZ

II. Dates (important events)

Enumeration Date: 12/19/2017
Last Update Date: 12/19/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7175 66TH ST N
PINELLAS PARK FL
33781-4004
US

IV. Provider business mailing address

10565 BLOSSOM LAKE DR
SEMINOLE FL
33772-7415
US

V. Phone/Fax

Practice location:
  • Phone: 727-369-0346
  • Fax:
Mailing address:
  • Phone: 305-305-0304
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246QM0706X
TaxonomyMedical Technologist
License NumberSU44198
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: