Provider Demographics
NPI:1225481633
Name:AGUILUZ, DYLAN (UP)
Entity Type:Individual
Prefix:
First Name:DYLAN
Middle Name:
Last Name:AGUILUZ
Suffix:
Gender:M
Credentials:UP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1104 SAINT ANN ST
Mailing Address - Street 2:
Mailing Address - City:MARRERO
Mailing Address - State:LA
Mailing Address - Zip Code:70072-2406
Mailing Address - Country:US
Mailing Address - Phone:504-402-6050
Mailing Address - Fax:504-336-3180
Practice Address - Street 1:7813 AIRLINE DR
Practice Address - Street 2:STE B
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70003-6462
Practice Address - Country:US
Practice Address - Phone:504-515-2303
Practice Address - Fax:504-336-3180
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-20
Last Update Date:2016-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health