Provider Demographics
NPI:1942349113
Name:CASPE, THEODORE GERARD AGUILAR (MD)
Entity Type:Individual
Prefix:DR
First Name:THEODORE GERARD
Middle Name:AGUILAR
Last Name:CASPE
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:12375 BASELINE RD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91739-5921
Mailing Address - Country:US
Mailing Address - Phone:909-899-6969
Mailing Address - Fax:909-899-9922
Practice Address - Street 1:12375 BASELINE RD
Practice Address - Street 2:SUITE 104
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91739-5921
Practice Address - Country:US
Practice Address - Phone:909-899-6969
Practice Address - Fax:909-899-9922
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-05
Last Update Date:2015-05-07
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAA97790207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1306068499OtherCORPORATE NPI