Provider Demographics
NPI:1669179206
Name:GROUPO AQUILA
Entity type:Organization
Organization Name:GROUPO AQUILA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DAMON
Authorized Official - Middle Name:F
Authorized Official - Last Name:CLARK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:213-380-1399
Mailing Address - Street 1:400 CORPORATE POINTE STE 300
Mailing Address - Street 2:
Mailing Address - City:CULVER CITY
Mailing Address - State:CA
Mailing Address - Zip Code:90230-7620
Mailing Address - Country:US
Mailing Address - Phone:213-380-1399
Mailing Address - Fax:
Practice Address - Street 1:400 CORPORATE POINTE STE 300
Practice Address - Street 2:
Practice Address - City:CULVER CITY
Practice Address - State:CA
Practice Address - Zip Code:90230-7620
Practice Address - Country:US
Practice Address - Phone:213-380-1399
Practice Address - Fax:213-380-4046
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-14
Last Update Date:2024-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No332S00000XSuppliersHearing Aid Equipment