Provider Demographics
NPI:1073761144
Name:AGUILAR, JAMIE R (LMT)
Entity Type:Individual
Prefix:
First Name:JAMIE
Middle Name:R
Last Name:AGUILAR
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1516 SPRUCE ST
Mailing Address - Street 2:
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81004-3429
Mailing Address - Country:US
Mailing Address - Phone:719-406-7831
Mailing Address - Fax:
Practice Address - Street 1:55 N SILICON DR
Practice Address - Street 2:
Practice Address - City:PUEBLO WEST
Practice Address - State:CO
Practice Address - Zip Code:81007-4443
Practice Address - Country:US
Practice Address - Phone:719-406-7831
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-03
Last Update Date:2008-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO15280174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist