Provider Demographics
NPI:1619267697
Name:AGUILERA, MARIA LOURDES D (WHNP-BC)
Entity Type:Individual
Prefix:
First Name:MARIA LOURDES
Middle Name:D
Last Name:AGUILERA
Suffix:
Gender:F
Credentials:WHNP-BC
Other - Prefix:
Other - First Name:MARIA
Other - Middle Name:
Other - Last Name:LLORENTE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:5301 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:WEST NEW YORK
Mailing Address - State:NJ
Mailing Address - Zip Code:07093-2622
Mailing Address - Country:US
Mailing Address - Phone:201-866-9320
Mailing Address - Fax:201-866-6782
Practice Address - Street 1:5301 BROADWAY AVENUE
Practice Address - Street 2:
Practice Address - City:WEST NEW YORK
Practice Address - State:NJ
Practice Address - Zip Code:07094
Practice Address - Country:US
Practice Address - Phone:201-866-9320
Practice Address - Fax:201-866-6782
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-12
Last Update Date:2014-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA04443100261QC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health