Provider Demographics
NPI:1861834178
Name:AGUILERA, IVAN BRANDO TEVES (DPM)
Entity Type:Individual
Prefix:DR
First Name:IVAN BRANDO
Middle Name:TEVES
Last Name:AGUILERA
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1485 UNIVERSITY AVE STE B
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92507-4497
Mailing Address - Country:US
Mailing Address - Phone:951-405-8500
Mailing Address - Fax:951-405-8555
Practice Address - Street 1:1485 UNIVERSITY AVE STE B
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92507-4497
Practice Address - Country:US
Practice Address - Phone:951-405-8500
Practice Address - Fax:951-405-8555
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-28
Last Update Date:2022-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE5245213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery