Provider Demographics
NPI:1013582642
Name:AGUAYO, JAVIER
Entity type:Individual
Prefix:
First Name:JAVIER
Middle Name:
Last Name:AGUAYO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:H11 CALLE 7
Mailing Address - Street 2:
Mailing Address - City:GURABO
Mailing Address - State:PR
Mailing Address - Zip Code:00778-2914
Mailing Address - Country:US
Mailing Address - Phone:939-272-4535
Mailing Address - Fax:
Practice Address - Street 1:H11 CALLE 7
Practice Address - Street 2:
Practice Address - City:GURABO
Practice Address - State:PR
Practice Address - Zip Code:00778-2914
Practice Address - Country:US
Practice Address - Phone:939-272-4535
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-25
Last Update Date:2021-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2145133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered