Provider Demographics
NPI:1568638179
Name:AGUILAR, JORGE ULISES (PA)
Entity Type:Individual
Prefix:MR
First Name:JORGE
Middle Name:ULISES
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 1:16143 SW 139TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33196-6464
Mailing Address - Country:US
Mailing Address - Phone:305-215-6027
Mailing Address - Fax:
Practice Address - Street 1:8900 SW 117TH AVE
Practice Address - Street 2:SUITE C 203
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33186-2175
Practice Address - Country:US
Practice Address - Phone:305-215-6027
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-03
Last Update Date:2008-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9100766363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical