Provider Demographics
NPI:1497017735
Name:AGUILAR, MIRNA L (MSED)
Entity Type:Individual
Prefix:MS
First Name:MIRNA
Middle Name:L
Last Name:AGUILAR
Suffix:
Gender:F
Credentials:MSED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:836 TILDEN ST
Mailing Address - Street 2:APT 2A
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10467-6028
Mailing Address - Country:US
Mailing Address - Phone:845-797-3125
Mailing Address - Fax:
Practice Address - Street 1:836 TILDEN ST
Practice Address - Street 2:APT 2A
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10467-6028
Practice Address - Country:US
Practice Address - Phone:845-797-3125
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-12
Last Update Date:2012-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY608455051174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist