Provider Demographics
NPI:1528024056
Name:AGUILAR, RICHARD BURT (MD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:BURT
Last Name:AGUILAR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7705 SEVILLE AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:HUNTINGTON
Mailing Address - State:CA
Mailing Address - Zip Code:90255-6315
Mailing Address - Country:US
Mailing Address - Phone:323-582-7406
Mailing Address - Fax:323-582-1862
Practice Address - Street 1:13768 SW 8TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33184-3030
Practice Address - Country:US
Practice Address - Phone:855-226-6633
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-24
Last Update Date:2022-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG62147207R00000X
ORMD26851207R00000X
FLME128129207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR006018Medicaid
OR006018Medicaid
CAG62147Medicare PIN