MEDICARE: MR. JOHN MANUEL AGUILAR JR. R.T.

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	247100000X	Radiologic Technologist	16255	TX

General Provider Information

NPI Number	:	1407885775
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JOHN MANUEL AGUILAR JR. R.T.

Provider Business Mailing Address
First Line	:	13 COLUMBELLA STREET
Second Line	:
City	:	BAY CITY
State	:	TX
Zip	:	77414
Country	:	US
Telephone Number	:	979-245-7331
Fax Number	:

Provider Business Practice Location Address
First Line	:	13 COLUMBELLA ST
Second Line	:
City	:	BAY CITY
State	:	TX
Zip	:	77414-2773
Country	:	US
Telephone Number	:	979-245-7331
Fax Number	:

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

Provider Enumeration Date	:	06/30/2006
Last Update Date	:	07/08/2007

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