Provider Demographics
NPI:1518277904
Name:GEMELIA HOLGADO AGUILERA, M.D. INC.
Entity Type:Organization
Organization Name:GEMELIA HOLGADO AGUILERA, M.D. INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:DR
Authorized Official - First Name:GEMELIA
Authorized Official - Middle Name:HOLGADO
Authorized Official - Last Name:AGUILERA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:323-663-2100
Mailing Address - Street 1:3761 BEVERLY BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90004-3528
Mailing Address - Country:US
Mailing Address - Phone:323-663-2100
Mailing Address - Fax:323-663-2065
Practice Address - Street 1:3761 BEVERLY BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90004-3528
Practice Address - Country:US
Practice Address - Phone:323-663-2100
Practice Address - Fax:323-663-2065
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GEMELIA HOLGADO AGUILERA, M.D. INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-10-19
Last Update Date:2010-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA46585207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A465851Medicaid
CAE88547Medicare UPIN