Provider Demographics
NPI:1942869664
Name:ARAGON, JORGE LUIS (BS)
Entity Type:Individual
Prefix:
First Name:JORGE
Middle Name:LUIS
Last Name:ARAGON
Suffix:
Gender:M
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3303 E BASELINE RD STE 203
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85234-2728
Mailing Address - Country:US
Mailing Address - Phone:480-300-5388
Mailing Address - Fax:480-535-5841
Practice Address - Street 1:3303 E BASELINE RD STE 203
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85234-2728
Practice Address - Country:US
Practice Address - Phone:480-300-5388
Practice Address - Fax:480-535-5841
Is Sole Proprietor?:No
Enumeration Date:2019-06-06
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ133NN1002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education