Healthcare Provider Details

I. General information

NPI: 1942571724
Provider Name (Legal Business Name): OLIVIA MARIE AGUILAR PA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/25/2012
Last Update Date: 01/25/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1471 E 84TH PL
MERRILLVILLE IN
46410-6451
US

IV. Provider business mailing address

1471 EAST 84 TH PLACE
MERRILLIVILLE IN
46410
US

V. Phone/Fax

Practice location:
  • Phone: 219-769-8630
  • Fax: 219-769-8633
Mailing address:
  • Phone: 219-769-8630
  • Fax: 219-769-8633

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number0000000000
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: