Provider Demographics
NPI:1417939042
Name:AGUILERA, SAMUEL RAMON (DC)
Entity Type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:RAMON
Last Name:AGUILERA
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5015 CANYON CREST DR
Mailing Address - Street 2:#109
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92507-6000
Mailing Address - Country:US
Mailing Address - Phone:951-682-2500
Mailing Address - Fax:
Practice Address - Street 1:5015 CANYON CREST DR
Practice Address - Street 2:#109
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92507-6000
Practice Address - Country:US
Practice Address - Phone:951-682-2500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-18
Last Update Date:2009-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC15115111N00000X, 111NX0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No111NX0100XChiropractic ProvidersChiropractorOccupational Health