Healthcare Provider Details

I. General information

NPI: 1730216003
Provider Name (Legal Business Name): MARIO R. AGUILAR M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/27/2007
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1240 S TELSHOR BLVD SUITE C
LAS CRUCES NM
88011-4731
US

IV. Provider business mailing address

1240 S TELSHOR BLVD SUITE C
LAS CRUCES NM
88011-4731
US

V. Phone/Fax

Practice location:
  • Phone: 505-522-1212
  • Fax: 505-522-2898
Mailing address:
  • Phone: 505-522-1212
  • Fax: 505-522-2898

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number85-2
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: