Provider Demographics
NPI:1093150682
Name:ARAGON, CARLOS ERNESTO
Entity Type:Individual
Prefix:MR
First Name:CARLOS
Middle Name:ERNESTO
Last Name:ARAGON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13645 GARFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH GATE
Mailing Address - State:CA
Mailing Address - Zip Code:90280-8172
Mailing Address - Country:US
Mailing Address - Phone:562-634-4365
Mailing Address - Fax:562-634-5866
Practice Address - Street 1:13645 GARFIELD AVE
Practice Address - Street 2:
Practice Address - City:SOUTH GATE
Practice Address - State:CA
Practice Address - Zip Code:90280-8172
Practice Address - Country:US
Practice Address - Phone:562-634-4365
Practice Address - Fax:562-634-5866
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-08
Last Update Date:2013-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA138240156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician