Provider Demographics
NPI:1245776426
Name:AGUILAR ESCAMILLA, ILIANA PAULINA (MS, BS,AAS,RD, LD)
Entity Type:Individual
Prefix:
First Name:ILIANA
Middle Name:PAULINA
Last Name:AGUILAR ESCAMILLA
Suffix:
Gender:F
Credentials:MS, BS,AAS,RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2237 NW 157TH ST
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73013-1729
Mailing Address - Country:US
Mailing Address - Phone:678-327-7825
Mailing Address - Fax:
Practice Address - Street 1:2237 NW 157TH ST
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73013
Practice Address - Country:US
Practice Address - Phone:678-327-7825
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-12
Last Update Date:2018-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
133V00000X
OK2221133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered