MEDICARE: CHRIS AGUILAR

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1003221466
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRIS AGUILAR

Provider Business Mailing Address
First Line	:	4469 MEADOWLARK WING WAY
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89084-2620
Country	:	US
Telephone Number	:	702-749-6332
Fax Number	:	702-749-6334

Provider Business Practice Location Address
First Line	:	4469 MEADOWLARK WING WAY
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89084-2620
Country	:	US
Telephone Number	:	702-749-6332
Fax Number	:	702-749-6334

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/24/2014
Last Update Date	:	06/24/2014

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Directions to “ CHRIS AGUILAR ” Practice Location

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