Provider Demographics
NPI:1972616100
Name:HOLGADO AGUILERA, GEMELIA (MD)
Entity Type:Individual
Prefix:
First Name:GEMELIA
Middle Name:
Last Name:HOLGADO AGUILERA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3761 BEVERLY BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90004
Mailing Address - Country:US
Mailing Address - Phone:323-663-2100
Mailing Address - Fax:323-663-2065
Practice Address - Street 1:3761 BEVERLY BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90004
Practice Address - Country:US
Practice Address - Phone:323-663-2100
Practice Address - Fax:323-663-2065
Is Sole Proprietor?:No
Enumeration Date:2006-08-15
Last Update Date:2010-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA46585207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A465851Medicaid
CAA46585AMedicare ID - Type Unspecified
CA00A465851Medicaid