Provider Demographics
NPI:1629036074
Name:AGUILAR, DAVID M (CFNP)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:M
Last Name:AGUILAR
Suffix:
Gender:M
Credentials:CFNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:49 HALEY CIR
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:NM
Mailing Address - Zip Code:88201-0301
Mailing Address - Country:US
Mailing Address - Phone:505-317-5472
Mailing Address - Fax:505-627-3838
Practice Address - Street 1:702 N 13TH ST
Practice Address - Street 2:
Practice Address - City:ARTESIA
Practice Address - State:NM
Practice Address - Zip Code:88210-1166
Practice Address - Country:US
Practice Address - Phone:505-748-8356
Practice Address - Fax:505-748-8305
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2010-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMR45422363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
343610901Medicare ID - Type Unspecified
323401Medicare Oscar/Certification