Provider Demographics
NPI:1265501266
Name:DE JESUS, ERNESTO AGUILAR JR (PHARMD)
Entity Type:Individual
Prefix:
First Name:ERNESTO
Middle Name:AGUILAR
Last Name:DE JESUS
Suffix:JR
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8715 COLBATH AVE
Mailing Address - Street 2:
Mailing Address - City:PANORAMA CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91402-3304
Mailing Address - Country:US
Mailing Address - Phone:818-892-7208
Mailing Address - Fax:
Practice Address - Street 1:1515 N VERMONT AVE # 237
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90027-5337
Practice Address - Country:US
Practice Address - Phone:323-783-3830
Practice Address - Fax:323-783-5506
Is Sole Proprietor?:No
Enumeration Date:2006-11-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA59092183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist