Healthcare Provider Details

I. General information

NPI: 1659969574
Provider Name (Legal Business Name): ISAAC CUAUHCOATL AGUILAR
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/06/2021
Last Update Date: 01/06/2021
Certification Date: 01/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3315 S 23RD ST STE 210
TACOMA WA
98405-1616
US

IV. Provider business mailing address

2701 N 12TH ST UNIT B
TACOMA WA
98406-7316
US

V. Phone/Fax

Practice location:
  • Phone: 253-572-8684
  • Fax:
Mailing address:
  • Phone: 323-839-7150
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number61092959
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: