Healthcare Provider Details

I. General information

NPI: 1417436106
Provider Name (Legal Business Name): PETRA MONICA AGUILAR RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/13/2018
Last Update Date: 08/13/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2424 WILCREST DR STE 110
HOUSTON TX
77042-2772
US

IV. Provider business mailing address

2424 WILCREST DR STE 110
HOUSTON TX
77042-2772
US

V. Phone/Fax

Practice location:
  • Phone: 713-666-8287
  • Fax: 713-660-8391
Mailing address:
  • Phone: 713-666-8287
  • Fax: 713-660-8391

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number862428
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: