Provider Demographics
NPI:1043726565
Name:AGUILERA, LUCITA (MT)
Entity Type:Individual
Prefix:
First Name:LUCITA
Middle Name:
Last Name:AGUILERA
Suffix:
Gender:F
Credentials:MT
Other - Prefix:
Other - First Name:LUCITA
Other - Middle Name:
Other - Last Name:AGUILERA DE LA PAZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10565 BLOSSOM LAKE DR
Mailing Address - Street 2:
Mailing Address - City:SEMINOLE
Mailing Address - State:FL
Mailing Address - Zip Code:33772-7415
Mailing Address - Country:US
Mailing Address - Phone:305-305-0304
Mailing Address - Fax:
Practice Address - Street 1:7175 66TH ST N
Practice Address - Street 2:
Practice Address - City:PINELLAS PARK
Practice Address - State:FL
Practice Address - Zip Code:33781-4004
Practice Address - Country:US
Practice Address - Phone:727-369-0346
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-19
Last Update Date:2017-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSU44198246QM0706X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246QM0706XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, PathologyMedical Technologist