Provider Demographics
NPI:1760490924
Name:JOSE AGUILAR M.D. A, MEDICAL CORPORATION
Entity Type:Organization
Organization Name:JOSE AGUILAR M.D. A, MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:E
Authorized Official - Last Name:AGUILAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:323-254-4100
Mailing Address - Street 1:6100 N FIGUEROA ST STE A
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90042-3578
Mailing Address - Country:US
Mailing Address - Phone:323-254-4100
Mailing Address - Fax:323-254-5810
Practice Address - Street 1:6100 N FIGUEROA ST STE A
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90042-3578
Practice Address - Country:US
Practice Address - Phone:323-254-4100
Practice Address - Fax:323-254-5810
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-04
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
A22133207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA22133OtherLICENSE #
CAAA1429251OtherDEA #