Provider Demographics
NPI:1417038175
Name:MIGNOSA, AURORA MARY (MD)
Entity Type:Individual
Prefix:
First Name:AURORA
Middle Name:MARY
Last Name:MIGNOSA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 18962
Mailing Address - Street 2:
Mailing Address - City:BELFAST
Mailing Address - State:ME
Mailing Address - Zip Code:04915-4084
Mailing Address - Country:US
Mailing Address - Phone:800-566-5050
Mailing Address - Fax:254-537-6869
Practice Address - Street 1:301 LONDONDERRY DR
Practice Address - Street 2:
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76712-7915
Practice Address - Country:US
Practice Address - Phone:254-751-4880
Practice Address - Fax:254-751-4885
Is Sole Proprietor?:No
Enumeration Date:2006-10-18
Last Update Date:2017-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM33242084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00N59XOtherBCBS TX
TX084249401Medicaid
TX182846902Medicaid
TX00N59XOtherBCBS TX
TX8J1858Medicare PIN