=====================================================
General NPI Number Information
=====================================================
NPI Number | 1760129019
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CHRISTOPHER MICHAEL AGUILA PA-C
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/18/2022
-----------------------------------------------------
Last Update Date | 08/14/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8750 SW 144TH ST STE 100
-----------------------------------------------------
City | PALMETTO BAY
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33176-7229
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-323-9658
-----------------------------------------------------
Fax | 786-596-3840
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8750 SW 144TH ST STE 100
-----------------------------------------------------
City | PALMETTO BAY
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33176-7229
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-323-9658
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363AM0700X
-----------------------------------------------------
Taxonomy Name | Medical Physician Assistant
-----------------------------------------------------
License Number | PA9115929
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------