Healthcare Provider Details

I. General information

NPI: 1114226669
Provider Name (Legal Business Name): JORGE AGUILA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/23/2011
Last Update Date: 12/14/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2040 W CHARLESTON BLVD STE 300
LAS VEGAS NV
89102-2227
US

IV. Provider business mailing address

2040 W CHARLESTON BLVD STE 300
LAS VEGAS NV
89102-2227
US

V. Phone/Fax

Practice location:
  • Phone: 702-671-2358
  • Fax: 702-671-2376
Mailing address:
  • Phone: 702-671-2358
  • Fax: 702-671-2376

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberR3984
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: