Provider Demographics
NPI:1891019485
Name:AGUILAR, JENNY MIRIAM
Entity Type:Individual
Prefix:MRS
First Name:JENNY
Middle Name:MIRIAM
Last Name:AGUILAR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10600 RAYITO PL
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79924-1916
Mailing Address - Country:US
Mailing Address - Phone:281-919-4418
Mailing Address - Fax:915-239-6268
Practice Address - Street 1:10600 RAYITO PL
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79924-1916
Practice Address - Country:US
Practice Address - Phone:281-919-4418
Practice Address - Fax:915-239-6268
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-25
Last Update Date:2010-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1540235335E00000X
TX335E0000X1540235335E00000X
TX335E00000X 1540235335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier