MEDICARE: NICK SALVADOR AGUILAR MD

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	207Q00000X	Family Medicine Physician	K4621	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	8BB290	OTHER	TX	BCBSTX

General Provider Information

NPI Number	:	1639176340
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICK SALVADOR AGUILAR MD

Provider Business Mailing Address
First Line	:	3303 ROGERS ROAD, SUITE 130
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78251-3650
Country	:	US
Telephone Number	:	210-520-2224
Fax Number	:	210-520-2238

Provider Business Practice Location Address
First Line	:	3303 ROGERS ROAD, SUITE 130
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78251-3650
Country	:	US
Telephone Number	:	210-520-2224
Fax Number	:	210-520-2238

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

Provider Enumeration Date	:	07/07/2005
Last Update Date	:	09/04/2015

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