Provider Demographics
NPI:1093475543
Name:AGUILAR, VLADIMIR (ACNPC-AG)
Entity Type:Individual
Prefix:
First Name:VLADIMIR
Middle Name:
Last Name:AGUILAR
Suffix:
Gender:M
Credentials:ACNPC-AG
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8442 VIA NORTE DR
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92503-7825
Mailing Address - Country:US
Mailing Address - Phone:951-452-3202
Mailing Address - Fax:
Practice Address - Street 1:29430 LINDEN PL
Practice Address - Street 2:
Practice Address - City:LAKE ELSINORE
Practice Address - State:CA
Practice Address - Zip Code:92530-9106
Practice Address - Country:US
Practice Address - Phone:951-452-3202
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-25
Last Update Date:2023-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95018916363LC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LC0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA95018916Medicaid