Provider Demographics
NPI:1245299817
Name:AGUILERA, TROY (MPT)
Entity type:Individual
Prefix:
First Name:TROY
Middle Name:
Last Name:AGUILERA
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7946 IVANHOE AVE
Mailing Address - Street 2:STE. 110
Mailing Address - City:LA JOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92037-4516
Mailing Address - Country:US
Mailing Address - Phone:858-551-8882
Mailing Address - Fax:858-551-0593
Practice Address - Street 1:7946 IVANHOE AVE
Practice Address - Street 2:STE. 110
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92037-4516
Practice Address - Country:US
Practice Address - Phone:858-551-8882
Practice Address - Fax:858-551-0593
Is Sole Proprietor?:No
Enumeration Date:2006-03-21
Last Update Date:2012-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA271312251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAFK053ZMedicare PIN