Healthcare Provider Details

I. General information

NPI: 1407286966
Provider Name (Legal Business Name): ALEC AGUILAR JR. LSA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/20/2013
Last Update Date: 01/12/2022
Certification Date: 01/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24506 FORT PATH DR
SPRING TX
77373-7670
US

IV. Provider business mailing address

PO BOX 3346
SPRING TX
77383-3346
US

V. Phone/Fax

Practice location:
  • Phone: 214-227-2457
  • Fax: 214-764-0880
Mailing address:
  • Phone: 214-227-2457
  • Fax: 214-764-0880

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code246ZC0007X
TaxonomySurgical Assistant
License Number4167
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code246ZC0007X
TaxonomySurgical Assistant
License NumberSA00768
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: