Provider Demographics
NPI:1457377152
Name:AGUILAR, CORAZON T (MD)
Entity type:Individual
Prefix:DR
First Name:CORAZON
Middle Name:T
Last Name:AGUILAR
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 1:1550 S POTOMAC ST STE 230
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80012-5455
Mailing Address - Country:US
Mailing Address - Phone:303-369-1077
Mailing Address - Fax:303-369-9785
Practice Address - Street 1:1550 S POTOMAC ST STE 230
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80012-5455
Practice Address - Country:US
Practice Address - Phone:303-369-1077
Practice Address - Fax:303-369-9785
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2018-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO19912208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01199124Medicaid
COAG01751OtherBLUE SHIELD
CO84-0994567OtherEIN
CO84-0994567OtherEIN