Provider Demographics
NPI:1841748779
Name:AGUILAR, JESSICA (PA-C)
Entity Type:Individual
Prefix:MISS
First Name:JESSICA
Middle Name:
Last Name:AGUILAR
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5105 S MCCOLL RD
Mailing Address - Street 2:
Mailing Address - City:EDINBURG
Mailing Address - State:TX
Mailing Address - Zip Code:78539-8278
Mailing Address - Country:US
Mailing Address - Phone:956-307-9254
Mailing Address - Fax:949-863-2674
Practice Address - Street 1:5105 S MCCOLL RD
Practice Address - Street 2:
Practice Address - City:EDINBURG
Practice Address - State:TX
Practice Address - Zip Code:78539-8278
Practice Address - Country:US
Practice Address - Phone:956-307-9254
Practice Address - Fax:949-863-2674
Is Sole Proprietor?:No
Enumeration Date:2016-09-20
Last Update Date:2016-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA10547363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical