Healthcare Provider Details

I. General information

NPI: 1548174279
Provider Name (Legal Business Name): LUIS AGUERO PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/30/2026
Last Update Date: 09/30/2026
Certification Date: 09/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 CALLE BARBOSA
ISABELA PR
00662-2956
US

IV. Provider business mailing address

12504 LIMPET DR
TAMPA FL
33625-6520
US

V. Phone/Fax

Practice location:
  • Phone: 813-363-0771
  • Fax:
Mailing address:
  • Phone: 813-363-0771
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number3196PA
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: