Provider Demographics
NPI:1659969574
Name:AGUILAR, ISAAC CUAUHCOATL
Entity Type:Individual
Prefix:
First Name:ISAAC
Middle Name:CUAUHCOATL
Last Name:AGUILAR
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2701 N 12TH ST UNIT B
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98406-7316
Mailing Address - Country:US
Mailing Address - Phone:323-839-7150
Mailing Address - Fax:
Practice Address - Street 1:3315 S 23RD ST STE 210
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98405-1616
Practice Address - Country:US
Practice Address - Phone:253-572-8684
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-06
Last Update Date:2021-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA61092959261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy