Provider Demographics
NPI:1023535309
Name:AGUILAR, LOURDES FERNANDA
Entity Type:Individual
Prefix:
First Name:LOURDES
Middle Name:FERNANDA
Last Name:AGUILAR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6914 31ST AVE FL 2
Mailing Address - Street 2:
Mailing Address - City:WOODSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11377-1217
Mailing Address - Country:US
Mailing Address - Phone:917-312-5936
Mailing Address - Fax:
Practice Address - Street 1:6914 31 AVENUE, 2 FLOOR
Practice Address - Street 2:
Practice Address - City:WOODISE
Practice Address - State:NY
Practice Address - Zip Code:11377
Practice Address - Country:US
Practice Address - Phone:917-312-5936
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-27
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator