MEDICARE: DR. CRISTETO AGUILOS POLVOROSA 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	208800000X	Urology Physician	F4994	TX

General Provider Information

NPI Number	:	1710972443
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CRISTETO AGUILOS POLVOROSA MD

Provider Business Mailing Address
First Line	:	1120 S 27TH ST
Second Line	:
City	:	NEDERLAND
State	:	TX
Zip	:	77627-6224
Country	:	US
Telephone Number	:	409-985-7404
Fax Number	:	409-727-6030

Provider Business Practice Location Address
First Line	:	1120 S 27TH ST
Second Line	:
City	:	NEDERLAND
State	:	TX
Zip	:	77627-6224
Country	:	US
Telephone Number	:	409-985-7404
Fax Number	:	409-727-6030

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

Provider Enumeration Date	:	09/19/2005
Last Update Date	:	01/18/2026

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