=====================================================
General NPI Number Information
=====================================================
NPI Number | 1972907228
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | JORGE A. AGUINAGA, MD
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/15/2014
-----------------------------------------------------
Last Update Date | 10/15/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 471 US HIGHWAY 1 SUITE 104
-----------------------------------------------------
City | KEY WEST
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33040-5625
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-923-9030
-----------------------------------------------------
Fax | 305-745-9875
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 471 US HIGHWAY 1 SUITE 104
-----------------------------------------------------
City | KEY WEST
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33040-5625
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-923-9030
-----------------------------------------------------
Fax | 305-745-9875
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | SOLE PROPRIETOR
-----------------------------------------------------
Name | DR. JORGE ANTONIO AGUINAGA
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 305-923-9030
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2084P0800X
-----------------------------------------------------
Taxonomy Name | Psychiatry Physician
-----------------------------------------------------
License Number | ME0077050
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------