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General NPI Number Information
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NPI Number | 1225579006
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Entity Type | Organization
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Legal Business Name | LG AGUILAR TABORA, MD INC
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Dates
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Enumeration Date | 03/14/2017
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Last Update Date | 12/28/2017
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Provider Practice Location Address
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Address Line | 8650 GENESSEE AVE. STE 214 #8684
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City | SAN DIEGO
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State | CA
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Zip | 92192-8684
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Country | US
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Telephone | 858-252-8655
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Fax | 619-930-9022
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Provider Business Mailing Address
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Address Line | PO BOX 928684
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City | SAN DIEGO
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State | CA
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Zip | 92192-8684
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Country | US
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Telephone | 858-252-8655
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Fax | 619-930-9022
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. LESLY GISELLE AGUILAR TABORA
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Credential | M.D.
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Telephone | 858-252-8655
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number | A106980
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License Number State | CA
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