MEDICARE: SERGIO RICARDO AGUILAR DDS

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	208D00000X	General Practice Physician	36881	CA

General Provider Information

NPI Number	:	1467566257
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SERGIO RICARDO AGUILAR DDS

Provider Business Mailing Address
First Line	:	520 N MAIN STREET
Second Line	:	SUITE 120
City	:	SANTA ANA
State	:	CA
Zip	:	92701-4623
Country	:	US
Telephone Number	:	714-835-4057
Fax Number	:	714-835-4058

Provider Business Practice Location Address
First Line	:	520 N MAIN STREET
Second Line	:	SUITE 120
City	:	SANTA ANA
State	:	CA
Zip	:	92701-4623
Country	:	US
Telephone Number	:	714-835-4057
Fax Number	:	714-835-4058

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

Provider Enumeration Date	:	08/18/2006
Last Update Date	:	08/14/2015

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