Healthcare Provider Details

I. General information

NPI: 1215970199
Provider Name (Legal Business Name): JUAN A. AGUILERA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/14/2006
Last Update Date: 01/24/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

807 N CAGE BLVD
PHARR TX
78577-3117
US

IV. Provider business mailing address

807 N CAGE BLVD
PHARR TX
78577-3117
US

V. Phone/Fax

Practice location:
  • Phone: 956-283-1889
  • Fax: 956-283-7014
Mailing address:
  • Phone: 956-283-1889
  • Fax: 956-283-7014

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: JUAN A. AGUILERA
Title or Position: OWNER
Credential: M.D.
Phone: 956-283-1889