=====================================================
General NPI Number Information
=====================================================
NPI Number | 1285674093
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LUZ MARIA AGUILAR M.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/08/2006
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 16555 NW 25TH AVE
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33054-6583
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 786-466-1707
-----------------------------------------------------
Fax | 305-624-5296
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 973 NW 106TH AVENUE CIR
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33172-3122
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-226-1480
-----------------------------------------------------
Fax | 305-226-1480
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208D00000X
-----------------------------------------------------
Taxonomy Name | General Practice Physician
-----------------------------------------------------
License Number | ME 0065553
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------