=====================================================
General NPI Number Information
=====================================================
NPI Number | 1104196955
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | AGUILAR & BALLEN PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/11/2012
-----------------------------------------------------
Last Update Date | 01/27/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 747 PONCE DE LEON BLVD SUITE 402
-----------------------------------------------------
City | CORAL GABLES
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33134-2073
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-774-5700
-----------------------------------------------------
Fax | 305-774-5900
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 747 PONCE DE LEON BLVD SUITE 402
-----------------------------------------------------
City | CORAL GABLES
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33134-2073
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-774-5700
-----------------------------------------------------
Fax | 305-774-5900
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. JUAN P AGUILAR
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 305-774-5700
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number | ME47476
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------