MEDICARE: DR. THEODORE GERARD AGUILAR CASPE 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	A97790	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1306068499	OTHER	CA	CORPORATE NPI

General Provider Information

NPI Number	:	1942349113
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. THEODORE GERARD AGUILAR CASPE MD

Provider Business Mailing Address
First Line	:	12375 BASE LINE RD STE 104
Second Line	:
City	:	RANCHO CUCAMONGA
State	:	CA
Zip	:	91739-5993
Country	:	US
Telephone Number	:	909-899-6969
Fax Number	:	909-899-9922

Provider Business Practice Location Address
First Line	:	12375 BASE LINE RD STE 104
Second Line	:
City	:	RANCHO CUCAMONGA
State	:	CA
Zip	:	91739-5993
Country	:	US
Telephone Number	:	909-899-6969
Fax Number	:	909-899-9922

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

Provider Enumeration Date	:	02/05/2007
Last Update Date	:	04/14/2026

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