Provider Demographics
NPI:1942452719
Name:RICHARD B. AGUILAR, P.C.
Entity Type:Organization
Organization Name:RICHARD B. AGUILAR, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR/M.D.
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:BURT
Authorized Official - Last Name:AGUILAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:323-582-7406
Mailing Address - Street 1:7705 SEVILLE AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:HUNTINGTON PARK
Mailing Address - State:CA
Mailing Address - Zip Code:90255-6315
Mailing Address - Country:US
Mailing Address - Phone:323-582-7406
Mailing Address - Fax:323-582-1862
Practice Address - Street 1:7705 SEVILLE AVE
Practice Address - Street 2:SUITE B
Practice Address - City:HUNTINGTON PARK
Practice Address - State:CA
Practice Address - Zip Code:90255-6315
Practice Address - Country:US
Practice Address - Phone:323-582-7406
Practice Address - Fax:323-582-1862
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-10
Last Update Date:2010-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG62147207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CABF643Medicare PIN
CAF28667Medicare UPIN
CAG62147Medicare PIN