Provider Demographics
NPI:1194821447
Name:AGUILERA, TONI ANGELA (CRNA)
Entity Type:Individual
Prefix:
First Name:TONI
Middle Name:ANGELA
Last Name:AGUILERA
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:913 VIA DE LA PAZ DR
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79912-6636
Mailing Address - Country:US
Mailing Address - Phone:479-414-9381
Mailing Address - Fax:
Practice Address - Street 1:913 VIA DE LA PAZ DR
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79912-6636
Practice Address - Country:US
Practice Address - Phone:479-414-9381
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-15
Last Update Date:2019-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARC01010367500000X
VA0024168346367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100849810AMedicaid
AR148188701Medicaid
AR148188701Medicaid
VA020273W82Medicare PIN