Provider Demographics
NPI:1114015500
Name:AGUILERA, MANUEL C (MD)
Entity Type:Individual
Prefix:DR
First Name:MANUEL
Middle Name:C
Last Name:AGUILERA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25616 ROLLING HILLS WAY
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90505-7048
Mailing Address - Country:US
Mailing Address - Phone:310-617-3895
Mailing Address - Fax:
Practice Address - Street 1:235 W CARSON ST
Practice Address - Street 2:
Practice Address - City:CARSON
Practice Address - State:CA
Practice Address - Zip Code:90745-2604
Practice Address - Country:US
Practice Address - Phone:310-834-4233
Practice Address - Fax:310-834-3356
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA38823207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA38823OtherSTATE LICENSE
CA954061927OtherTAX ID
CAGR0025530Medicaid
CAGR0025530Medicaid
CAA38823OtherSTATE LICENSE
CA954061927OtherTAX ID