Healthcare Provider Details

I. General information

NPI: 1811078579
Provider Name (Legal Business Name): MARIO R. AGUILAR, M.D.,P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/18/2006
Last Update Date: 06/04/2014
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: 575-522-1212
  • Fax: 575-522-2898
Mailing address:
  • Phone: 575-522-1212
  • Fax: 575-522-2898

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. MARIO R. AGUILAR
Title or Position: PRESIDENT
Credential: M.D.
Phone: 575-522-1212