Healthcare Provider Details

I. General information

NPI: 1558464966
Provider Name (Legal Business Name): JOSE A AGUINAGA PAC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/07/2006
Last Update Date: 01/19/2024
Certification Date: 01/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

227 W KLEBERG AVE
KINGSVILLE TX
78363-4427
US

IV. Provider business mailing address

6101 BLUE LAGOON DR STE 200
MIAMI FL
33126-3168
US

V. Phone/Fax

Practice location:
  • Phone: 361-592-6451
  • Fax: 361-595-4545
Mailing address:
  • Phone: 561-570-5172
  • Fax: 786-472-5770

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA02119
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: