Provider Demographics
NPI:1477995504
Name:AGUILAR, NELSON (PA)
Entity Type:Individual
Prefix:
First Name:NELSON
Middle Name:
Last Name:AGUILAR
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5475 N VIA SEMPREVERDE
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85750-5973
Mailing Address - Country:US
Mailing Address - Phone:714-718-4286
Mailing Address - Fax:
Practice Address - Street 1:8134 SPECTRUM
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92618-7359
Practice Address - Country:US
Practice Address - Phone:904-657-8524
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-17
Last Update Date:2022-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ7652363AM0700X
CACA52846363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Multi-Specialty