Provider Demographics
NPI:1851597066
Name:AGUILA-CORRALES, JUANITA RODRIGUEZ (MD)
Entity Type:Individual
Prefix:DR
First Name:JUANITA
Middle Name:RODRIGUEZ
Last Name:AGUILA-CORRALES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:JUANITA
Other - Middle Name:AGUILA
Other - Last Name:CORRALES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:530 N.E. GLEN OAK
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61637-0001
Mailing Address - Country:US
Mailing Address - Phone:773-484-1000
Mailing Address - Fax:309-655-2974
Practice Address - Street 1:1 ILLINI DRIVE
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61605-2576
Practice Address - Country:US
Practice Address - Phone:309-671-8504
Practice Address - Fax:309-671-8513
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-25
Last Update Date:2021-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0361141942080N0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036-114194OtherSTATE LICENSE