Provider Demographics
NPI:1598812596
Name:AGUILUZ, AMABLE R JR (MD)
Entity Type:Individual
Prefix:
First Name:AMABLE
Middle Name:R
Last Name:AGUILUZ
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:8 BAYVIEW DR
Mailing Address - Street 2:
Mailing Address - City:BUENA PARK
Mailing Address - State:CA
Mailing Address - Zip Code:90621-1677
Mailing Address - Country:US
Mailing Address - Phone:714-994-4009
Mailing Address - Fax:714-994-4009
Practice Address - Street 1:21500 PIONEER BLVD
Practice Address - Street 2:SUITE 209
Practice Address - City:HAWAIIAN GARDENS
Practice Address - State:CA
Practice Address - Zip Code:90716-2600
Practice Address - Country:US
Practice Address - Phone:562-402-4151
Practice Address - Fax:562-402-6533
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-04
Last Update Date:2011-11-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA33886207PE0004X, 207Q00000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA33886OtherMEDICAL LICENSE