Healthcare Provider Details

I. General information

NPI: 1770395675
Provider Name (Legal Business Name): JUSTIN AGUAYO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/27/2025
Last Update Date: 01/27/2025
Certification Date: 01/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 NAVEL NUCLEAR POWER TRAINING COMMAND CIRCLE
GOOSE CREEK SC
29445
US

IV. Provider business mailing address

1050 REGISTER ST
NORTH CHARLESTON SC
29405-2421
US

V. Phone/Fax

Practice location:
  • Phone: 843-794-6000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1710I1003X
TaxonomyIndependent Duty Medical Technicians
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: