Provider Demographics
NPI:1568852580
Name:AMABLE R. AGUILUZ JR. MD INC.
Entity Type:Organization
Organization Name:AMABLE R. AGUILUZ JR. MD INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:AMABLE
Authorized Official - Middle Name:DELOS REYES
Authorized Official - Last Name:AGUILUZ
Authorized Official - Suffix:II
Authorized Official - Credentials:MD
Authorized Official - Phone:562-860-2442
Mailing Address - Street 1:21500 PIONEER BLVD STE 209
Mailing Address - Street 2:
Mailing Address - City:HAWAIIAN GARDENS
Mailing Address - State:CA
Mailing Address - Zip Code:90716-2605
Mailing Address - Country:US
Mailing Address - Phone:562-860-2442
Mailing Address - Fax:562-402-3601
Practice Address - Street 1:21500 PIONEER BLVD STE 209
Practice Address - Street 2:
Practice Address - City:HAWAIIAN GARDENS
Practice Address - State:CA
Practice Address - Zip Code:90716-2605
Practice Address - Country:US
Practice Address - Phone:562-860-2442
Practice Address - Fax:562-402-3601
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-29
Last Update Date:2015-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA33886261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA84532Medicare UPIN
CADI925AMedicare PIN