MEDICARE: DR. VIRGINIA C AGUILA M.D.

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	15873	NE

General Provider Information

NPI Number	:	1831203959
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. VIRGINIA C AGUILA M.D.

Provider Business Mailing Address
First Line	:	2500 CALIFORNIA PLAZA
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68178
Country	:	US
Telephone Number	:	402-280-5823
Fax Number	:	402-280-2129

Provider Business Practice Location Address
First Line	:	7909 N 30TH ST
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68112-2418
Country	:	US
Telephone Number	:	402-280-4780
Fax Number	:

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

Provider Enumeration Date	:	08/18/2006
Last Update Date	:	07/08/2007

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