Provider Demographics
NPI:1043581481
Name:AGUILAR, PABLO D (LMT)
Entity Type:Individual
Prefix:
First Name:PABLO
Middle Name:D
Last Name:AGUILAR
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12210 SW 39TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33175-3014
Mailing Address - Country:US
Mailing Address - Phone:786-210-6218
Mailing Address - Fax:305-265-2010
Practice Address - Street 1:12210 SW 39TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33175-3014
Practice Address - Country:US
Practice Address - Phone:786-210-6218
Practice Address - Fax:305-265-2010
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-17
Last Update Date:2012-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA64272225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist