Healthcare Provider Details

I. General information

NPI: 1467439265
Provider Name (Legal Business Name): RICARDO COSME AGUILAR JR. M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/22/2005
Last Update Date: 05/08/2024
Certification Date: 05/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2515 CASTROVILLE RD STE 1
SAN ANTONIO TX
78237-3361
US

IV. Provider business mailing address

2515 CASTROVILLE RD STE 1
SAN ANTONIO TX
78237-3361
US

V. Phone/Fax

Practice location:
  • Phone: 210-290-8350
  • Fax: 210-290-8325
Mailing address:
  • Phone: 210-290-8350
  • Fax: 210-290-8325

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2083P0011X
TaxonomyUndersea and Hyperbaric Medicine (Preventive Medicine) Physician
License NumberK8603
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberK8603
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: