Provider Demographics
NPI:1851306724
Name:JACQUELINE B. AGUILUZ, D.O. INC
Entity Type:Organization
Organization Name:JACQUELINE B. AGUILUZ, D.O. INC
Other - Org Name:TOWNE CENTER FAMILY MEDICAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:JACQUELINE
Authorized Official - Middle Name:B
Authorized Official - Last Name:AGUILUZ
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:5628-655-2214
Mailing Address - Street 1:21508 NORWALK BLVD
Mailing Address - Street 2:
Mailing Address - City:HAWAIIAN GARDENS
Mailing Address - State:CA
Mailing Address - Zip Code:90716-1122
Mailing Address - Country:US
Mailing Address - Phone:562-865-5214
Mailing Address - Fax:562-865-3619
Practice Address - Street 1:21508 NORWALK BLVD
Practice Address - Street 2:
Practice Address - City:HAWAIIAN GARDENS
Practice Address - State:CA
Practice Address - Zip Code:90716-1122
Practice Address - Country:US
Practice Address - Phone:562-865-5214
Practice Address - Fax:562-865-3619
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-29
Last Update Date:2008-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A7451207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00AX74510Medicaid
CA00AX74510Medicaid