Healthcare Provider Details

I. General information

NPI: 1336132067
Provider Name (Legal Business Name): FEDERICO AGUILAR MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/29/2005
Last Update Date: 11/14/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1050 JABARRAH AVE SEYMOUR JOHNSON AFB
GOLDSBORO NC
27531-2310
US

IV. Provider business mailing address

1050 JABARRAH AVE SEYMOUR JOHNSON AFB
GOLDSBORO NC
27531-2310
US

V. Phone/Fax

Practice location:
  • Phone: 919-722-0928
  • Fax: 919-722-1952
Mailing address:
  • Phone: 919-722-0928
  • Fax: 919-722-1952

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number155975
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: