Healthcare Provider Details

I. General information

NPI: 1225847452
Provider Name (Legal Business Name): LAURA AGUILAR CHW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/02/2025
Last Update Date: 01/02/2025
Certification Date: 01/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 40TH ST
LUBBOCK TX
79404-2746
US

IV. Provider business mailing address

PO BOX 445
LUBBOCK TX
79408-0445
US

V. Phone/Fax

Practice location:
  • Phone: 806-743-9355
  • Fax: 806-743-9363
Mailing address:
  • Phone: 806-743-1347
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number8640
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: