Provider Demographics
NPI:1518242619
Name:AGUILAR, JAZMYN MARTHA (LMT)
Entity Type:Individual
Prefix:MISS
First Name:JAZMYN
Middle Name:MARTHA
Last Name:AGUILAR
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10231 E COLONIAL DR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32817-4331
Mailing Address - Country:US
Mailing Address - Phone:407-730-3371
Mailing Address - Fax:407-730-3372
Practice Address - Street 1:10231 E COLONIAL DR
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32817-4331
Practice Address - Country:US
Practice Address - Phone:407-730-3371
Practice Address - Fax:407-730-3372
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-20
Last Update Date:2011-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA57113320700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320700000XResidential Treatment FacilitiesResidential Treatment Facility, Physical Disabilities