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General NPI Number Information
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NPI Number | 1619267697
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Entity Type | Individual
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Provider Name | MARIA LOURDES D. AGUILERA WHNP-BC
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Gender | Female
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Dates
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Enumeration Date | 04/12/2011
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Last Update Date | 06/04/2014
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Provider Practice Location Address
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Address Line | 5301 BROADWAY AVENUE
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City | WEST NEW YORK
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State | NJ
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Zip | 07094
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Country | US
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Telephone | 201-866-9320
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Fax | 201-866-6782
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Provider Business Mailing Address
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Address Line | 5301 BROADWAY
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City | WEST NEW YORK
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State | NJ
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Zip | 07093-2622
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Country | US
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Telephone | 201-866-9320
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Fax | 201-866-6782
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QC1500X
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Taxonomy Name | Community Health Clinic/Center
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License Number | 25MA04443100
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License Number State | NJ
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