Provider Demographics
NPI:1770829392
Name:AGUILAR, JUAN ANGEL JR
Entity Type:Individual
Prefix:MR
First Name:JUAN
Middle Name:ANGEL
Last Name:AGUILAR
Suffix:JR
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 1:4149 TWEEDY BLVD
Mailing Address - Street 2:SUITE J
Mailing Address - City:SOUTH GATE
Mailing Address - State:CA
Mailing Address - Zip Code:90280-6167
Mailing Address - Country:US
Mailing Address - Phone:323-567-3333
Mailing Address - Fax:323-567-2929
Practice Address - Street 1:4149 TWEEDY BLVD
Practice Address - Street 2:SUITE J
Practice Address - City:SOUTH GATE
Practice Address - State:CA
Practice Address - Zip Code:90280-6167
Practice Address - Country:US
Practice Address - Phone:323-567-3333
Practice Address - Fax:323-567-2929
Is Sole Proprietor?:No
Enumeration Date:2012-12-31
Last Update Date:2012-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA76391126800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes126800000XDental ProvidersDental Assistant