Provider Demographics
NPI:1326528563
Name:AGUILAR, GEREMIAS JR
Entity Type:Individual
Prefix:
First Name:GEREMIAS
Middle Name:
Last Name:AGUILAR
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:481 E AVENUE 28 APT 4
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90031-2076
Mailing Address - Country:US
Mailing Address - Phone:562-246-2347
Mailing Address - Fax:
Practice Address - Street 1:481 E AVENUE 28 APT 4
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90031-2076
Practice Address - Country:US
Practice Address - Phone:562-246-2347
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-16
Last Update Date:2018-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA88938126800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes126800000XDental ProvidersDental Assistant