Provider Demographics
NPI:1174352041
Name:AGUILAR PEREZ, LEONARDO (SA-C)
Entity type:Individual
Prefix:
First Name:LEONARDO
Middle Name:
Last Name:AGUILAR PEREZ
Suffix:
Gender:M
Credentials:SA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8210 SW 65TH AVE APT 3
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33143-7922
Mailing Address - Country:US
Mailing Address - Phone:786-486-9946
Mailing Address - Fax:
Practice Address - Street 1:8210 SW 65TH AVE APT 3
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33143-7922
Practice Address - Country:US
Practice Address - Phone:786-486-9946
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-30
Last Update Date:2024-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL24-350246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant